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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197601334
Report Date: 08/09/2023
Date Signed: 08/09/2023 11:47:32 AM


Document Has Been Signed on 08/09/2023 11:47 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:AYRES RESIDENTIAL CARE HOMEFACILITY NUMBER:
197601334
ADMINISTRATOR:GABAI, MICHAELFACILITY TYPE:
740
ADDRESS:10940 AYRES AVE.TELEPHONE:
(310) 475-4727
CITY:LOS ANGELESSTATE: CAZIP CODE:
90064
CAPACITY:6CENSUS: 6DATE:
08/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:46 AM
MET WITH:Michael Gabai, AdministratorTIME COMPLETED:
12:00 PM
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On 8/9/23, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA met with Administrator Michael Gabai and explained the purpose of today’s visit. The facility is licensed to operate for six (6) residents of which six (6) non-ambulatory elderly residents ages 60 and above. The facility is approved for three (3) hospice. Todays census is 6.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: six (6) resident's rooms with all six having their individual bathroom, 1 office room with a bathroom, living area, dining area, kitchen, laundry area room in hallway and outside shaded patio area.

LPA Shirley and Michael Gabai toured the physical plant. There are no bodies of water or firearms on the premises. All client rooms were checked. Beds and bedding were in good condition, adequate lighting provided, storage for client personal belongings was observed. Walls and floors were in good repair. Bed linens and comforters were in good condition at the time of the inspection. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 116.8 F. All fire extinguishers were operable.

A comfortable temperature is maintained in the facility. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were inaccessible to clients. The kitchen was inspected and there is enough perishable and non-perishable food available which is stored properly. Smoke detectors and carbon Monoxide were operable.

LPA also observed that the facility has a 30-day supply of Personal Protective Equipment (PPE). And all mandated posters were posted.

There were no deficiencies observed during today’s visit. Exit interview held and a copy of the report was provided to the director, Michael Gabai.

SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa ShirleyTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2023
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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