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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607366
Report Date: 03/25/2024
Date Signed: 03/25/2024 02:17:49 PM


Document Has Been Signed on 03/25/2024 02:17 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:GARDENA RETIREMENT CENTERFACILITY NUMBER:
197607366
ADMINISTRATOR:SUSANA FUENTESFACILITY TYPE:
740
ADDRESS:14741 S. VERMONT AVE.TELEPHONE:
(310) 327-4091
CITY:GARDENASTATE: CAZIP CODE:
90247
CAPACITY:108CENSUS: 96DATE:
03/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Susie Fuentes, DirectorTIME COMPLETED:
03:30 PM
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On 3/25/24, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced annual required using the CARE Inspection Tool. LPA met with Susana Fuentes/Director. LPA explained the purpose of today’s visit. The facility is licensed to serve (108) non-ambulatory elderly adults ages 60 and above. Today’s census is 96.

The facility is a two-story structure located in a commercial neighborhood. It consists of the following: (54) resident bedrooms. Each room has a bathroom in the unit. The facility houses an activity room, dining area, kitchen, administrative offices, outside patio with shaded area and TV room on second floor.

LPA Shirley and Susie toured the physical plant. There are no bodies of water or firearms on the premises. Five (5) client rooms were checked, rooms: 9,39,44,45 and 47and call buttons. Beds and bedding were in good condition, adequate lighting provided, storage for client personal belongings was observed. Walls and floors were in good repair. Bathrooms were found to be within Title 22 regulations and were clean and operational.



A comfortable temperature is maintained in the facility. LPA observed the facility to be clean and appropriately furnished at the time of visit. The kitchen was inspected and LPA observed supplies of perishable and non-perishable food available for a minimum of one week which is stored properly. Fire extinguishers were charged, smoke detectors and carbon Monoxide were operable. LPA checked first aid kit; and found that it was compliant with a manual. The water temperature measured 105.6 F. There is a working landline phone available in the lobby for client use.

Con'd on 809-C
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa ShirleyTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 03/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/25/2024
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


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: GARDENA RETIREMENT CENTER
FACILITY NUMBER: 197607366
VISIT DATE: 03/25/2024
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LPA reviewed P&I money for 2 of the 5 residents, P&I were intact.

LPA observed that medications were safe, locked and inaccessible to clients in care. Last Disaster drill was conducted on 2/17/24.


There were no deficiencies observed during today’s visit. Exit interview held and a copy of the report was provided to the Administrator, Susie Fuentes.
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa ShirleyTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024
LIC809 (FAS) - (06/04)
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