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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608859
Report Date: 09/16/2021
Date Signed: 09/28/2021 06:47:31 PM

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
MONTEREY PARK, CA 91754
FACILITY NAME:EILAT'S MANORFACILITY NUMBER:
197608859
ADMINISTRATOR:MIRIAM RUDESFACILITY TYPE:
740
ADDRESS:1621 S. SHERBOURNE DRIVETELEPHONE:
(310) 273-3133
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY:6CENSUS: 6DATE:
09/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Harrix ManuelTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA’s) Martessa Brown and Licensing Program Manager (LPM) Janae Hammond conducted an unannounced Annual required visit with a primary focus on infection control measures. LPA was met by Garrix Manuel, Caregiver and the purpose of today’s visit was explained. The facility is licensed to serve 6 Residential Care Elderly.

There are currently (6) residents at the facility, 6 Non-Ambulatory of which 1 may be bedridden. LPA and LPM observed all 6 residents were fine. The facility is a single story structure located in a residential neighborhood. Home consists of the following: 5 bedrooms, 2 bathrooms, family room/dining room, kitchen, living room, outdoor shaded area.



LPA and staff toured the physical plant with the Caregiver. There are no bodies of water or firearm/ammunition on the premises. All residents bedrooms were checked. Beds and bedding were in good condition, adequate lighting provided. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 102 F. A comfortable temperature is maintained in the facility. 2nd bathroom was designated for staff only. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were inaccessible to clients. The kitchen was inspected and there is enough perishable and non-perishable food available which is stored properly. Fire extinguisher was in the medicine cabinet and not mounted on the wall, smoke detectors were operable but there was no Carbon Monoxide at the facility.

LIC 809-C is on the next page
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa BrownTELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021
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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: EILAT'S MANOR
FACILITY NUMBER: 197608859
VISIT DATE: 09/16/2021
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During the visit, LPA observed did not observed screening protocols for visitors, staff and residents, sanitizing stations (Located in common areas and restrooms). LPA observed staff were wearing face coverings. LPA did not observe an isolation room with the required postings throughout the facility. LPA did observe the facility During the visit, LPA observed did not observed screening protocols for visitors, staff and residents, sanitizing stations (Located in common areas and restrooms). LPA observed staff were wearing face coverings. LPA did not observe an isolation room with the required postings throughout the facility. LPA did observe the facility as a 30-day supply of Personal Protective Equipment (PPE). LPA observe a couple of “No Visitors signs” that should be removed.

Administrator should continuously monitor the Centers for Disease Control (CDC) website and Community Care Likening Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance.

Deficiencies may be issued at a later date.

Exit interview held. A copy of the report was provided to Caregiver.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa BrownTELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021
LIC809 (FAS) - (06/04)
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