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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606947
Report Date: 03/21/2024
Date Signed: 03/21/2024 02:47:43 PM


Document Has Been Signed on 03/21/2024 02:47 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:NAMUAG GUEST HOMEFACILITY NUMBER:
197606947
ADMINISTRATOR:LEONIDA NAMUAGFACILITY TYPE:
740
ADDRESS:2440 GONDER AVENUETELEPHONE:
(562) 343-2260
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY:6CENSUS: 6DATE:
03/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Leonida Namuag/AdministratorTIME COMPLETED:
02:46 PM
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On 3/21/2024, Licensing Program Analysts (LPAs) Darneisha Cross and Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Leonida Namuag /Administrator. LPA explained the purpose of today’s visit. Facility is licensed for (4) non-ambulatory and (2) ambulatory residents ages 60 and above. Rooms #1 and #2 are cleared for ambulatory residents only. Rooms #3 and #4 are cleared for non-ambulatory. Approved hospice waive for (4) residents.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: 4 bedrooms, 3 bathrooms, family room/dining room, kitchen, living room, shaded area, indoor and outdoor activity area, laundry room and detached garage.

LPA Iniguez toured the physical plant with an administrator. There were no bodies of water or obstructions on the premises. A total of (3) rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident’s personal belongings was observed. Bathrooms were found to be within Title 22 regulations and were operational. LPA inspected the carbon monoxide detectors combo were in operable condition. The water temperature properly measures between: 105°F-120°F: Kitchen 110.5°F, Bathroom #1:109°F.

Evaluation Report Continues LIC 809-C

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: NAMUAG GUEST HOME
FACILITY NUMBER: 197606947
VISIT DATE: 03/21/2024
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LPAs Iniguez and Cross observed the facility to be clean, sanitary, and appropriately furnished at the time of the visit. Storage areas for personal hygiene were observed. Sharps objects and cleaning agents were locked and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available at the property. All fire extinguishers were charged and were operable. A review of (3) resident records and (3) staff records were conducted. LPA Cross and Iniguez checked (3) Medication Administration Records (MAR) and no discrepancies were found. The first AID kit was checked. The last facility disaster drill was: 1/15/2024.

LPA observed the facility's infection control practices. A copy of the liability insurance was given to LPA during this visit. Facility annual fees are current.



According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies therefore no citations were issued at this time.

An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Leonida Namuag /Administrator.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
LIC809 (FAS) - (06/04)
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