197607600-1-23-2025-11-AS-YROR-DD83QX-20250123172751

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607600
Report Date: 01/23/2025
Date Signed: 01/23/2025 05:27:58 PM

Document Has Been Signed on 01/23/2025 05:27 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:	DIANE'S FAMILY & FRIENDS		FACILITY NUMBER:	197607600
ADMINISTRATOR/ DIRECTOR:	DIANE SIGUR		FACILITY TYPE:	740
ADDRESS:	11235 S. VAN NESS AVE.		TELEPHONE:	(323) 755-6616
CITY:	INGLEWOOD	STATE: CA	ZIP CODE:	90303
CAPACITY: 4; 4	TOTAL ENROLLED CHILDREN: 0	CENSUS: 3	DATE:	01/23/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:05 PM
MET WITH:	Diane Sigur, Administrator		TIME VISIT/ INSPECTION COMPLETED:	05:27 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 01/23/25 Licensing Program Analyst (LPA) Yolanda Rosser conducted an unannounced required annual visit using the CARE Inspection Tool. Upon arrival at the facility LPA Rosser met with Administrator, Diane Sigur and explained the purpose of today's visit. LPA Rosser verified that the facility has an approved Mitigation Plan Report and Infection Control Plan. Census is currently three (3) Westside Regional Center (WRC), Residential Care Facility for the Elderly (RCFE) consumers in placement. The facility is a single-story family home located in a residential neighborhood. Ms. Sigur and LPA Rosser toured the facility which consisted of a Living room, dining room, kitchen, three (3) bedrooms, two (2) bathrooms, laundry room, detached garage, shaded area, and indoor/outdoor activity areas. Bedrooms #1-2 are designated as residents’ bedrooms. Documents are posted as mandated on the dining room wall bulletin board. The following Title 22 Regulated areas were audited and found to be in compliance: Bedrooms contain the required furniture. Personal accommodations were observed for safety, privacy, and comfort, including grab bars, and non-skid surface mats. The living areas are clean, bathrooms are clean and operational. The first aid kit is fully stocked with manual, the hot water temperature was measured at 108.7 degrees Fahrenheit, working telephone, smoke and carbon monoxide detectors were in compliance, fire extinguishers are fully charged, medications were centrally stored and properly locked in the laundry room cabinet and records are current, ample supply of perishable and nonperishable food, adequate linen supply, fire/emergency drill conducted on December 23, 2024. No firearms on the premises, all exit doors were in compliance, covered trash cans, and no bodies of water were present. Hazardous items are inaccessible to clients, the yard is free of debris and hazards. Cutlery was securely locked in bedroom. There is staff that is not associated with the facility to be cited. Exit interview was conducted, copy of report and appeal rights were provided.

Eva M Alvarez	TELEPHONE: (323) 629-7047
Yolanda Rosser	TELEPHONE: (424) 544-1082
	DATE: 01/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025

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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Document Has Been Signed on 01/23/2025 05:27 PM - It Cannot Be Edited

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: DIANE'S FAMILY & FRIENDS	FACILITY NUMBER: 197607600
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

87355(e)(2)

Criminal record clearance e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on (record review)], staff member #1 is not associated to the facility. Staff has been working since 04/24/2024 which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 01/24/2025
	Plan of Correction
1 2 3 4	Administrator will submit a transfer request to the department or associate staff #1 in Guardian by POC due date. A $500.00 civil penalty is assessed.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Eva M Alvarez	TELEPHONE: (323) 629-7047
Yolanda Rosser	TELEPHONE: (424) 544-1082
	DATE: 01/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025

LIC809 (FAS) - (06/04)

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