<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603198
Report Date: 10/09/2024
Date Signed: 10/09/2024 02:46:19 PM

Document Has Been Signed on 10/09/2024 02:46 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:BRIGHTEN COTTAGES - PARKCRESTFACILITY NUMBER:
198603198
ADMINISTRATOR/
DIRECTOR:		ROMAN, ELSAFACILITY TYPE:
740
ADDRESS:5818 E PARKCREST STREETTELEPHONE:
(562) 452-7409
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 6CENSUS: 6DATE:
10/09/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Carl Beboso, CaregiverTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/09/2024, LPA Zina Brown made an unannounced case management deficiency visit and met with Carl Beboso, Caregiver during today visit and explained the purpose of today's visit.

LPA Brown conducted an annual inspection on Monday, September 30, 2024. During the inspection, based on an interview, Administrator Jose Umana indicated that the resident was not bedridden, despite the physician's report stating otherwise.

On Tuesday, October 8, 2024, Administrator Jose Umana sent an email clarifying that the resident he previously told LPA was not bedridden is, in fact, bedridden, based on further clarification from the doctor. He also stated that the resident is currently located in bedroom #6, which has an exit sliding door near the garage.

Based on interview, record review, and observation, Resident #1 (bedridden) is currently in bedroom #6, instead of bedroom #5, which is the room cleared for bedridden residents per the fire clearance. This presents an immediate health and safety risk to the resident.

As a result, an immediate $500 civil penalty has been issued today, Wednesday, October 9, 2024.

Deficiency cited under California Code of Regulation Title 22, Division 6, Chapter 8.

An exit interview was conducted, with a copy of appeal rights, and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE: DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2024
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
Document Has Been Signed on 10/09/2024 02:46 PM - It Cannot Be Edited


Created By: Zina Brown On 10/09/2024 at 01:12 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BRIGHTEN COTTAGES - PARKCREST
FACILITY NUMBER: 198603198

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/10/2024
Section Cited
CCR
87202(a)

1
2
3
4
5
6
7
Fire Clearance 87202(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district . . .
This requirement is not met as evidence by:
1
2
3
4
5
6
7
The administrator stated he will contact the families of residence who resided in bedroom #5 and bedroom #6 to get approve of switch the bedridden client in the clear room based on fire clearance. Administrator state he will send pictures within 24 hours of POC date.

8
9
10
11
12
13
14
Based on interview, record review & observation bedridden resident #1 is currently in bedroom # 6 & is not bedroom #5 which is cleared for bedridden resident per the fire clearance assigned for bedridden resident. This poses as a immediately health & safety risk in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Janae Hammond
LICENSING EVALUATOR NAME:Zina Brown
LICENSING EVALUATOR SIGNATURE:
DATE: 10/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2024


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