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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608867
Report Date: 05/28/2021
Date Signed: 05/28/2021 12:02:46 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
MONTERY PARK, CA 91754
FACILITY NAME:SANTA MONICA HOME & CARE 1FACILITY NUMBER:
197608867
ADMINISTRATOR:GARYSTRATHEARN/JENNIFER BLFACILITY TYPE:
740
ADDRESS:912-10TH STREET FRONT AND BTELEPHONE:
(310) 576-0044
CITY:SANTA MONICASTATE: CAZIP CODE:
90403
CAPACITY:6CENSUS: DATE:
05/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Gary Strathen and Svetlana DagalaTIME COMPLETED:
12:15 PM
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On 05/28/21, Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA met with administrator Gary Strathern and staff Svetlana Dagala and explained the purpose of today’s visit. The facility is licensed for (6 residents), 2 non-ambulatory and 4 ambulatories. Facility has a hospice waiver for three (3). Currently, there are 5 residents, all are over the age of 60.

The facility is a two-story structure located in a residential neighborhood. The first-floor licensed facility consists of the following: four (4) resident, three (3) bathrooms, living room, dining room, kitchen and enclosed patio/activity room area.

LPA and licensee toured the physical plant. There were no bodies of water or obstructions on the premises. Beds and bedding supplies were in good condition, adequate lighting provided, storage for client personal belongings was observed. 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.

LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage area cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Eight (8) smoke detectors were observed to be hardwired and interconnected. Facility has two extinguishers, both fully charged.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie CifuentesTELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2021
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
MONTERY PARK, CA 91754
FACILITY NAME: SANTA MONICA HOME & CARE 1
FACILITY NUMBER: 197608867
VISIT DATE: 05/28/2021
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During the visit, LPA observed the facility infection control practices. LPA observed screening protocol for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted and available.

No deficiencies were cited during this inspection visit.

An exit interview was conducted and a copy of this report was provided to Gary Strathern by email.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie CifuentesTELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2021
LIC809 (FAS) - (06/04)
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