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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603664
Report Date: 07/19/2023
Date Signed: 07/24/2023 09:00:24 AM


Document Has Been Signed on 07/24/2023 09:00 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:PATRICIA'S ELDER CAREFACILITY NUMBER:
197603664
ADMINISTRATOR:BRITO, PATRICIAFACILITY TYPE:
740
ADDRESS:2446 W. 234TH ST.TELEPHONE:
(310) 530-8946
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY:6CENSUS: 6DATE:
07/19/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Gener David, AdministratorTIME COMPLETED:
09:30 AM
NARRATIVE
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On 07/19/2023 at 8:05 AM Licensing Program Analyst (LPA) David España met with Gener David, Administrator and Linda, caregiver. The purpose of this visit is to document deficiencies observed during investigation of a complaint with complaint control number 11-AS-20230717150226.

On 07/19/2023 at 8:05 AM LPA España and Gener David, Administrator observed and interviewed the water heater smelling like gas. LPA and David, Administrator discussed maintenance of water heater, the Administrator could not provide a date for maintenance nor proof of maintenance dated by service provider. LPA noted that the water heater is located between kitchen and living area as specified in approved floor plan. LPA noted with the Administrator that the water heater may have bacteria inside and a licensed service provided needs to check for any detectable gas leaks.

LPA España and Gener David, Administrator discussed who the present Administrator was for Patricia's Elder Care: The Administrator stated he has been the Administrator for years at Patricia's Elder Care.LPA explained the purpose of having up to date information with the department, as this complaint visit has showed to suggest Patricia's Elder Care has not updated the Administrator information for years.The licensee’s failure to correct a repeated violation may result in the violation of California Code of Regulations (Title 22, Division 6, Chapter 8), as deficiencies were observed and citations were issued.

An exit interview was conducted, plans of correction were developed and a copy of the report and appeal rights were provided.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/24/2023
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 07/24/2023 09:00 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754


FACILITY NAME: PATRICIA'S ELDER CARE
FACILITY NUMBER: 197603664

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/28/2023
Section Cited
CCR
87406(3)(A-I)

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*Amendment of 809 delivered on 7/19/23 to add the deficiency page which provide the correct regulations/citations...(3) Submit a completed Application for...sure, certification or other approvals as specified in Sections 87406(b)(3)(B)(i) and (ii).
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Licensee will update Administrator’s information no later than POC due date and provide licensing with proof via fax or email (David.espana@dss.ca.gov).
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This requirement was not met as evidence by: Based on observation, LPA observed the Administrator has not updated current Administrator as read on facility profile. This presents a health and safety risk to client in care.
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Type B
08/19/2023
Section Cited
CCR87303(a)(b)

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*Amendment of 809 delivered on 7/19/23 to add the deficiency page which provide the correct regulations/citations..(a) The facility shall be clean, safe, sanitary and in good repair at all times... Maintenance shall include provision...(b) A comfortable temperature...(3) Nothing in this section...individual thermostatic...
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Licensee will maintenance water heater no later than POC due date and provide licensing with proof via fax or email (David.espana@dss.ca.gov).
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This requirement was not met as evidence by: Based on observation, LPA observed the Administrator has not maintenance water heater. This presents a health and safety risk to client in care.
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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 CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 07/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/24/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2