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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004356
Report Date: 12/06/2023
Date Signed: 12/06/2023 03:53:36 PM

Document Has Been Signed on 12/06/2023 03:53 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:INTEGRATED LIFEFACILITY NUMBER:
306004356
ADMINISTRATOR:CORINA M. DE LEONFACILITY TYPE:
775
ADDRESS:3634 ATLANTIC AVENUETELEPHONE:
(562) 726-1037
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY: 30CENSUS: 28DATE:
12/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:23 AM
MET WITH:Leslie Ramirez, Program ManagerTIME COMPLETED:
04:24 PM
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On 12/06/23 Licensing Program Analyst (LPA) Mario Leon conducted an unannounced annual inspection at the above-mentioned facility. LPA was met by Program Manager, Leslie Ramirez and the purpose of today’s visit was explained. The facility is licensed to serve 30 adult clients with behavioral issues.

There are currently twenty-eight (28) clients in care, twenty-seven (27) of which are ambulatory, with one (1) non-ambulatory client who attends virtually. The facility is a 1-story structure with six (6) rooms which include activity room, relaxation room, kitchen and work out room, teaching rooms, computer room and staff offices and three (3) bathrooms.
LPA and Program Manager Ramirez toured the physical plant.
There are no bodies of water or firearms/ammunition on the premises. All client rooms were checked and are in good condition and well maintained. LPA noted adequate lighting was provided to staff and clients, storage for client personal belongings was observed. Walls and floors were in good repair. All equipment, computers and work stations are well maintained and there is adequate PPE stocked at the time of visit. LPA observed Bathrooms were found to be within Title 22 regulations and were clean and operational. LPA noted the following: Bathroom #1 hot water temperature properly measured at 119.6 degrees Fahrenheit, and bathroom #2 hot water temperature properly measured at 119.4 degrees Fahrenheit, Kitchen hot water temperature properly measured at 119.8 degrees Fahrenheit. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were not accessible to clients. The facilities’ last fire drill was conducted by staff on 11/28/23. LPA noted seven (7) Smoke/Carbon Monoxide detectors were hard wired with alarm strobes throughout the facility. The facilities' three (3) Fire Extinguishers were checked and found to be fully charged and accessible, purchased March 08, 2023. Three (3) clients files were reviewed and were found with outdated Individual Service Plans all beyond one year mark, see LIC9102TV. LPA reviewed two (2) client’s medications and they were all found to be administered according to doctor's orders.
Report Continues, see LIC809C.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: INTEGRATED LIFE
FACILITY NUMBER: 306004356
VISIT DATE: 12/06/2023
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Two (2) staff files were checked and have the required documents. The facility does not handle client’s money/cash resources.

During today’s visit there were no deficiencies cited under California code of regulation title 22, division 6, chapter 8. There was one Advisory Note, see LIC9102TV.

An exit interview was held with, and copy of the report was provided to, Program Manager, Leslie Ramirez.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
LIC809 (FAS) - (06/04)
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