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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004356
Report Date: 07/14/2025
Date Signed: 07/14/2025 12:21:57 PM

Document Has Been Signed on 07/14/2025 12:21 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:INTEGRATED LIFEFACILITY NUMBER:
306004356
ADMINISTRATOR/
DIRECTOR:		CORINA M. DE LEONFACILITY TYPE:
775
ADDRESS:3634 ATLANTIC AVENUETELEPHONE:
(562) 726-1037
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY: 30CENSUS: 20DATE:
07/14/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:47 AM
MET WITH:Catherine BennageTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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On July 14, 2025, Licensing Program Analyst (LPA) Deborah Lee arrived at the facility listed above to conduct an unannounced Case Management-Other visit. LPA met with Catherine Bennage, Administrator and explained the purpose of the visit.

LPA is following up on multiple Unusual Incident Reports (UIR) and SOC341 sent to the Department regarding the following: Physical aggression—client on client, Physical aggression--property destruction, physical aggression, harm to self. Within the past 6 months, there have been a total of 10 such reports with physical aggression--client on client accounting for the majority of the reports at 7.

The Case Management visit consisted of:

On 7/14/25, LPA obtained and reviewed the following: staff/client group schedule for the month of July 2025, staff de-escalation training (CPI) sign-in sheet (dated 7/9/25), outings schedule for July 2025, and Behavior consultant schedule for July 2025.

On 7/14/25, LPA conducted 1 staff interview Administrator (A1) and toured the facility observing staff/client group ratios.

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NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Deborah Lee
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: INTEGRATED LIFE
FACILITY NUMBER: 306004356
VISIT DATE: 07/14/2025
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The Case Management visit revealed the following:

On 7/14/25, LPA interviewed Administrator (A1) who stated that the program maintains a staff/client ratio of 1 staff to 3 clients. A1 also stated that the program maintains 3 “float” staff to utilize when needed. Additionally, the ratio becomes 1 staff to 2 clients as needed for clients who exhibit challenging behaviors. A1 further stated that the program provides 2 in service training per month for the staff. The second in service (per month) is designated for A1 to review the clients’ behavior plans including any updates with the staff.

On 7/14/25, LPA reviewed staff/client schedule which showed the 1:3 ratio as mentioned by A1 during the interview. LPA also reviewed the outings schedule which indicated the ratios are maintained during outings. Lastly, LPA reviewed the behavior consultant schedule. The program receives at total of 80 hours per month provided by 3 consultants assigned to the program.

On 7/14/25, LPA toured the facility and observed staff/client groups. LPA observed that the ratios are maintained in the various groups. Additionally, LPA spoke with the behavior consult who stated that he comes out the program 2 times per week.

Lastly, LPA found that the the administrator is sending SIRs in accordance reporting requirements.

There were no deficiencies cited during today’s visit.

Exit interview conducted and copy of report was provided to Catherine Bennage

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NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Deborah Lee
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025
LIC809 (FAS) - (06/04)
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