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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191601607
Report Date: 08/01/2024
Date Signed: 08/01/2024 04:17:15 PM

Document Has Been Signed on 08/01/2024 04:17 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:SENASAC HOUSEFACILITY NUMBER:
191601607
ADMINISTRATOR/
DIRECTOR:		LATASHIA HAMMONDFACILITY TYPE:
735
ADDRESS:3748 SENASACTELEPHONE:
(562) 421-3889
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY: 6CENSUS: 4DATE:
08/01/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Staff - Carmen VasquezTIME VISIT/
INSPECTION COMPLETED:
04:30 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 08/01/2024 around 3:00 PM Licensing Program Analyst (LPA) Socorro Leandro arrived to the facility mentioned above. LPA met with staff Carmen Vasquez and explained the purpose of the visit.

Deficiency and Civil Penalty cited under California Code of Regulations, Title 22.
Deficiency regarding Acceptance and Retention Limitations for Client 1.
Client 1 was diagnosed with Alzheimer & Dementia in 2023 and then again in 2024.

An exit interview was conducted, and a copy of this report, deficiency, and civil penalty was left to staff along with their Appeal Rights.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2024
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 08/02/2024 01:07 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 08/02/2024 10:33 AM


Created By: Socorro Leandro On 08/01/2024 at 03:21 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SENASAC HOUSE
FACILITY NUMBER: 191601607

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
08/13/2024
Section Cited
CCR
85068.4(b)

1
2
3
4
5
6
7
(b) The licensee may admit or retain persons...whose needs are compatible with those of other clients if they require the same level of care and supervision as the other clients in the facility and the licensee is able to meet their needs. This requirement was not met as evidence by:
1
2
3
4
5
6
7
Licensee will work with Regional Center and create a plan to assist Client 1 (C1) in relocation. C1 will relocate to another facility where their needs can be met. Email proof of correction to Socorro.Leandro@dss.ca.gov.
8
9
10
11
12
13
14
Based on observations, the licensee did not comply with the section cited above in allowing Client 1 with a diagnosis of alzheimer & dementia to maintain residency in the facility, which poses a potential health and safety risks to persons 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:Ulysses Coronel
LICENSING EVALUATOR NAME:Socorro Leandro
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2024


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