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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191603774
Report Date: 02/18/2025
Date Signed: 02/18/2025 02:46:07 PM

Document Has Been Signed on 02/18/2025 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:CANTERBURY, THEFACILITY NUMBER:
191603774
ADMINISTRATOR/
DIRECTOR:		DAVE HONEFACILITY TYPE:
741
ADDRESS:5801 WEST CRESTRIDGE ROADTELEPHONE:
(310) 541-2410
CITY:RANCHO PALOS VERDESSTATE: CAZIP CODE:
90274
CAPACITY: 187CENSUS: 147DATE:
02/18/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:55 AM
MET WITH:Dave Hone - Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On 02/18/25, Licensing Program Analyst (LPA) Troy Watson made an unannounced visit regarding the relocation of from The MonteCedro Facility# 197610430 to the facility listed above due to mandatory evacuation orders from Fire Advisory. LPA Watson met with Dave Hone and explained the reason of the visit. LPA also spoke with the Director of Residential Health Service Nicole Prescott, and the LVN Care Suites Nurse Manager Lorena Bautista.

During the visit, LPA Watson conducted a health and safety check. LPA reviewed medication administration records (MARS) to obtain the names and date of birth from The MonteCedro Facility resident#1-resident # 9 (R1 – R9). Per interview of the Licensee Robin Gordon, nine residents have been relocated to The Canterbury. The facility has sufficient beds, bedding, hygiene supplies and linens. The facility has 141 bedrooms and 195 five bathrooms. The kitchen has sufficient two-day perishables and seven-day non-perishable food supplies. Medications and MARS for the MonteCedro residents have been transferred to the Canterbury and is in the Canterbury computer system and nursing stations. Residents#1-Residents#4 (R1-R4) require incontinence care and are ambulatory with standby assistance, and residents # 5 – residents # 9 (R5-R9) are continent requiring wheelchairs.

The Licensee stated each resident uses different vendors, pharmacy, and home health agencies, but the facility can maintain the same level of continued care for the residents. There is sufficient staffing available to provide care for all residents relocated from MonteCedro. It has been verified that a routine fire inspection for the
Canterbury was on 02/10/2025 and testing was complete on 02/10/2025 and a fire drill was conducted on 12/21/2024. The licensee confirmed all families, responsible parties, home health, and hospice agencies for The MonteCedro residents have been notified about the relocation either via calls, texts, or emails.

An exit interview was conducted with Dave Hone the Executive Director and a copy of this report was provided.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
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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