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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191670439
Report Date: 04/11/2022
Date Signed: 04/11/2022 04:45:50 PM

Document Has Been Signed on 04/11/2022 04:45 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME:CHANDLER FAMILY HOMEFACILITY NUMBER:
191670439
ADMINISTRATOR:JONES, SHIRLEY A.FACILITY TYPE:
735
ADDRESS:9116 CRENSHAW BLVD.TELEPHONE:
(323) 777-2131
CITY:INGLEWOODSTATE: CAZIP CODE:
90305
CAPACITY: 10CENSUS: DATE:
04/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Shirley JonesTIME COMPLETED:
04:40 PM
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On 4/11/2022, Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA spoke with Administrator Shirley Jones to conduct the covid-19 screener questionnaire and was informed the facility is free of Covid-19. LPA was met by staff and explained the purpose of today’s visit is the annual inspection concentrating on Infection control measures and was allowed entry into the facility. The facility is an Adult Residential Facility serving ages 18 to 59, licensed for 10 ambulatory clients. There are currently ten(10) clients in placement.

The facility is a single-story home located in a residential neighborhood. The facility consists of 5 client bedrooms, 1 freezer room, 2 bathrooms, 1 living room, 2 kitchens and a dining area.

LPA and staff toured the physical plant. There were no bodies of water or obstructions on the premises. Beds and bedding supplies were in good condition, adequate lighting provided, storage for client personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were clean and operational.

LPA observed the facility to be sanitary and appropriately furnished at the time of visit. The kitchen was inspected and there is a 2-day supply of perishable and a 7-day supply of non-perishable food available, maintained properly.

During the visit, LPA observed the facility infection control practices. LPA observed screening protocol for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings, a 30-day supply of Personal Protective Equipment (PPE) is available and sign in and out logs for visitors and staff are present in the facility.

Advisories are on attached 9102-AN

An exit interview was conducted, and a copy of this report was provided to Shirley Jones.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2022
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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