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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608867
Report Date: 05/23/2024
Date Signed: 05/23/2024 02:55:23 PM


Document Has Been Signed on 05/23/2024 02:55 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: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: 4DATE:
05/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:16 AM
MET WITH:GARY STRATHEARN/JENNIFER STRATHEARN, ADMINISTRATORSTIME COMPLETED:
03:30 PM
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On 05/23/2024 Licensing Program Analyst (LPA) David España conducted an unannounced annual required visit with a primary focus on using the CARE Inspection Tool. LPA met with Administrator Gary Strathearn and explained the purpose of today’s visit. The facility is licensed for (6 residents), (2) non-ambulatory, (4) ambulatories and Hospice Waiver for (3). Currently, there are 4 residents, all are over the age of 60. The facility is a one-story structure located in a residential neighborhood. The first-floor licensed facility consists of the following: four (4) resident rooms, three (3) bathrooms, living room, dining room, kitchen and enclosed patio/activity room area. LPA observed four (4) residents in care at the time of visit. LPA and Administrator 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. The water temperature ranged from 117.5F°. The room temperature ranged from 76F° – 78F°.

CONTINUE ON LIC 809C
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2024
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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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: SANTA MONICA HOME & CARE 1
FACILITY NUMBER: 197608867
VISIT DATE: 05/23/2024
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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. Smoke detectors were observed to be hardwired and interconnected. Facility has fire extinguishers, fully charged.

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.



According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies therefore no citations were issued at this time.

An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Administrator Gary Strathearn
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
LIC809 (FAS) - (06/04)
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