197607349-9-19-2024-11-AS-RCLD-D99QFK-20240919120804

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607349
Report Date: 09/19/2024
Date Signed: 09/19/2024 12:08:42 PM

Document Has Been Signed on 09/19/2024 12:08 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	J & A COMPASSIONATE CARE II		FACILITY NUMBER:	197607349
ADMINISTRATOR:	ALICE GALANG		FACILITY TYPE:	740
ADDRESS:	2160 W. 236TH STREET		TELEPHONE:	(310) 326-2868
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90501
CAPACITY:	6	CENSUS: 4	DATE:	09/19/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	House Manager Angelito Costa		TIME COMPLETED:	12:20 PM

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On 09/19/24, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with House Manager Angelito Costa. The facility is licensed to serve six (6) bedridden residents with a hospice waiver approved for one (1) terminally ill resident.

The facility is an one-story house located in a residential neighborhood and consists of four (4) resident bedrooms, one (1) staff bedroom, three (3) bathrooms, kitchen, living room/TV room, dining room, shaded patio and a garage. The facility is clean, sanitary, and in good repair. Protective devices are in place, including non-slip mats and grab bars in all showers.

The House Manager accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards.

Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Continue to LIC809-C.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: J & A COMPASSIONATE CARE II	FACILITY NUMBER: 197607349
	VISIT DATE: 09/19/2024

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Common areas were clean and clear of hazards, doorways were free of obstructions.

LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were kept in locked storage cabinet. First Aid kit was available. One fire extinguisher, purchase September 2024, was observed near the front door. The House Manager tested the carbon monoxide detector and smoke detectors in the house. Both devices were functional.

Four staff records were reviewed, 4 out of 4 staff records had required criminal record clearances or criminal record exemptions.

Four resident records were reviewed and, 4 out of 4 resident records had medical assessments and needs and services plan. Two residents’ medication was reviewed.

No deficiencies are being cited.

An exit interview was conducted, technical assistance provided, and a copy of this report was discussed and left with the House Manager Angelito Costa.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

LIC809 (FAS) - (06/04)

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