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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607366
Report Date: 09/24/2020
Date Signed: 09/25/2020 08:37:30 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME:GARDENA RETIREMENT CENTERFACILITY NUMBER:
197607366
ADMINISTRATOR:AMY PRATTFACILITY TYPE:
740
ADDRESS:14741 S. VERMONT AVE.TELEPHONE:
(310) 327-4091
CITY:GARDENASTATE: CAZIP CODE:
90247
CAPACITY:108CENSUS: 70DATE:
09/24/2020
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Amy Pratt TIME COMPLETED:
12:00 PM
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On 09/24/20 at 11:00 am 11:35 am Licensing Program Analyst(s) LPA/Ernand Dabuet and LPA/Jose Calderon initiated a Collateral visit at this facility. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s investigation visit was conducted via FaceTime with Amy Pratt, the administrator of this facility. LPAs explained the purpose of this visit is to gather information regarding a current complaint about Carson Senior Assisted Living 11-AS-20200821101916.

The visit consisted of an interview with Amy Pratt/Administrator with regard to (R-1) residence at this facility. Details on the interview are documented on LIC 812 crossed reference with Carson Senior Assisted Living facility number 198204950.

A telephonic exit interview was conducted with Amy Pratt, and a hard copy was provided via email for signature.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020
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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