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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191601265
Report Date: 07/19/2023
Date Signed: 08/10/2023 09:01:19 AM

Document Has Been Signed on 08/10/2023 09:01 AM - 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:GARDENA SENIOR CITIZENS DAY CARE CENTERFACILITY NUMBER:
191601265
ADMINISTRATOR:CHRISTINA THEOBALDFACILITY TYPE:
775
ADDRESS:14517 SO. CRENSHAW BLVD.TELEPHONE:
(310) 217-9550
CITY:GARDENASTATE: CAZIP CODE:
90249
CAPACITY: 30CENSUS: 0DATE:
07/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Erica YamashiroTIME COMPLETED:
03:45 PM
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On 7/19/23, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced annual required visit with a primary focus on Infection Control measures. LPA met with Nutritionist Services Coordinator Ericka Yamashiro and explained the purpose of today’s visit. The facility is licensed for sixty (30) ambulatory clients of which twenty-four (24) may be non-ambulatory.

The facility is a one story structure on the grounds of a church. Facility grounds consists of (1) administrative offices, (1) kitchen area, (1) activity rooms, (2) bathrooms, (1) classroom, (1) storage room, and an outside patio area. Common areas such as bathroom and the main activity rooms were observed. There is also an outdoor patio area for clients to utilize.

LPA Felisa and Ericka Yamashiro toured the physical plant. There were no bodies of water or obstructions on the premises. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water delivered at 114.9 F.

LPA observed the facility to be in a state of remodeling at the time of visit. Two (2) fire extinguishers were observed to be fully charged.


No deficiencies were cited during this inspection visit.

An exit interview was conducted, and a hard copy of this report was provided to Erika Yamashiro by email.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2023
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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