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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606579
Report Date: 07/30/2024
Date Signed: 07/30/2024 12:19:05 PM


Document Has Been Signed on 07/30/2024 12:19 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 CRP RO, 300 N. CONTINENTAL BLVD. #290B
EL SEGUNDO, CA 90245



FACILITY NAME:DYER GROUP HOMEFACILITY NUMBER:
197606579
ADMINISTRATOR:DYER, BRENDAFACILITY TYPE:
730
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:6CENSUS: 1DATE:
07/30/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Rosie Mexicano-House ManagerTIME COMPLETED:
12:30 PM
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On July 30, 2024 at 9:30am Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting an Annual/Random inspection. LPA was met by House Manager, Rosie Mexicano (S1) and allowed into the facility. The facility capacity is 4 ambulatory, developmentally disabled clients. The house layout is as follows:

Bedroom #1 has a single bed. The room is for one client. The room is equip with a dresser and a closet with sufficient clothing space. Bedroom #2 has two beds two dressers and closet space for two clients clothing. Bedroom #3 Has one queen bed with a dresser and closet space for clothing. Bedroom #4 is a separation room which has a bed, dresser and closet space. Bedroom 5 is currently empty. LPA was informed that the room is being converted to the house office. Master suite is for house Manager Rosie Marie Mexicano which has an attached bathroom. (S1) reported there are no fire arms or weapons in the home.

There are two bathroom located in the hallway next to the bedrooms. Both bathrooms are clean and in good working condition.

There is an in-ground pool on premises with a white fence surrounding it. Fencing has a self latching gate that opens outward with latch at the top. Gate is kept locked when the pool is not in use and per Manager children are supervised at all times when in or around the pool by staff members. NOTE: The gate to the pool is kept locked when not in use. HM stated that per Regional Center, the pool must be locked when housing Regional Center clients. The water shut off valve is on the side of the home in the backyard. the Electric shut off is on the opposite side of the home in the front. The facility is clean, safe, sanitary, and in good repair. Disinfectants/poisons and other hazardous items are inaccessible, they are kept locked in the Laundry Room. There is an adequate food supply (4 days perishable and at least 10 days non-perishable). Nutritious snacks are served between meals.

Cont 809-C
SUPERVISOR'S NAME: JoAunne GriffinTELEPHONE: (310) 916-8782
LICENSING EVALUATOR NAME: Donald C MartinTELEPHONE: (424) 301-3026
LICENSING EVALUATOR SIGNATURE:
DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CRP RO, 300 N. CONTINENTAL BLVD. #290B
EL SEGUNDO, CA 90245
FACILITY NAME: DYER GROUP HOME
FACILITY NUMBER: 197606579
VISIT DATE: 07/30/2024
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There was plenty of perishable and non perishable food accessible to the clients and a menu posted on the refrigerator. Medication is locked in a cabinet located in the kitchen. The living room has three couches and a TV on the wall. The Children's Personal Rights is posted, upheld and Staff have been instructed to report Personal Rights Violations. The vehicle is a 2010 Cadillac Escalade. The vehicle is in good working condition and the registration and insurance is up to date. There was plenty of extra towels and linen for the clients use. The garage stays locked and is inaccessible to clients.

Two client files were reviewed. Clients Physicals and Dental exams were up to date.

Three Staff files were reviewed. All required documentation was current and in the files.

Staff interviews were conducted. No Client interviews were conducted because the client is Non-Verbal.

There are no excluded persons on premises and All adults working in the home have Criminal Clearances. Facility has a current Plan of Operation and HM has been instructed to report changes in the plan of operation which affects clients.



There were no deficiencies cited at the time of the visit.
SUPERVISOR'S NAME: JoAunne GriffinTELEPHONE: (310) 916-8782
LICENSING EVALUATOR NAME: Donald C MartinTELEPHONE: (424) 301-3026
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
LIC809 (FAS) - (06/04)
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