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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607301
Report Date: 12/03/2024
Date Signed: 12/03/2024 02:32:34 PM

Document Has Been Signed on 12/03/2024 02:32 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:SERENITY SENIORS HOME IFACILITY NUMBER:
197607301
ADMINISTRATOR/
DIRECTOR:
MAYA K. ASTIERFACILITY TYPE:
740
ADDRESS:217 S. ESSEY AVE.TELEPHONE:
(310) 763-7879
CITY:COMPTONSTATE: CAZIP CODE:
90221
CAPACITY: 10TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
12/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Licensee Maya Astier TIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 12/03/24, Licensing Program Analyst (LPA) Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Licensee Maya Astier as the purpose of the visit was explained. Licensee was provided with upcoming fees info. Facility is licensed to serve 9 non-ambulatory and 1 bedridden developmentally disabled residents age 60 and above. Facility may accept or retain 1 resident on hospice. Residents are linked to the South Central Los Angeles Regional center. Facility has active liability Insurance with expiration date of 03/24/2025.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: 5 bedrooms, 6 bathrooms, family room/office, living room, kitchen, dining room, indoor and outdoor activity area, a detached garage that house emergency water and food supply, and has a laundry room inside. Bedrooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathroom toilets and water faucets worked properly, shower was free of mold/mildew, and there are sufficient toiletries accessible to clients. The water temperature properly measured between 105-120 F.. A supply of perishable and non-perishable food was observed, toxins and knifes were stored and inaccessible to clients, no weapons nor bodies of water on the premises, exits and walkways are free of debris/hazards.

LPA conducted a records review of 2 staff records, 4 resident records, and 4 medication administration records, no discrepancies observed. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The last fire was conducted on 10/01/24, fire extinguisher fully charged, carbon monoxide and smoke detectors are operational.

No discrepancies were observed, exit interview conducted, and a copy of this report was provided.

Janae HammondTELEPHONE: (424) 544-1027
Lizeth VillegasTELEPHONE: (818) 391-9974
DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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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