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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197608859
Report Date:
07/25/2024
Date Signed:
07/25/2024 11:07:23 AM
Document Has Been Signed on
07/25/2024 11:07 AM
- 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:
EILAT'S MANOR
FACILITY NUMBER:
197608859
ADMINISTRATOR:
MIRIAM RUDES
FACILITY TYPE:
740
ADDRESS:
1621 S. SHERBOURNE DRIVE
TELEPHONE:
(310) 273-3133
CITY:
LOS ANGELES
STATE:
CA
ZIP CODE:
90035
CAPACITY:
6
CENSUS:
6
DATE:
07/25/2024
TYPE OF VISIT:
Case Management - Annual Continuation
UNANNOUNCED
TIME BEGAN:
08:49 AM
MET WITH:
Eilat Nahum
TIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Sparkle Day conducted a continued Annual visit from 7/24/2025. During todays visit LPA met with Eilat Nahum who assisted with the visit.
LPA conducted a records review of (5) client records and (5) staff records. LPA reviewed (4) medication Administration records. All Resident & Staff records were complete. The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA did not observe any discrepancies at the time of visit
.
Exit interview conducted with Eilat Nahum and a copy of this report was left .
SUPERVISOR'S NAME:
Janae Hammond
TELEPHONE:
(424) 544-1027
LICENSING EVALUATOR NAME:
Sparkle Day
TELEPHONE:
(424) 544-1075
LICENSING EVALUATOR SIGNATURE:
DATE:
07/25/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/25/2024
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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