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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609366
Report Date: 08/31/2023
Date Signed: 08/31/2023 04:04:20 PM


Document Has Been Signed on 08/31/2023 04:04 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:SANTA MONICA HOME & CARE 2FACILITY NUMBER:
197609366
ADMINISTRATOR:GARY STRATHEARNFACILITY TYPE:
740
ADDRESS:912 10TH ST UNIT ATELEPHONE:
(310) 576-0044
CITY:SANTA MONICASTATE: CAZIP CODE:
90403
CAPACITY:4CENSUS: 3DATE:
08/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:37 PM
MET WITH:Gary StrathearnTIME COMPLETED:
04:05 PM
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On 8/31/2023, Licensing Program Analyst (LPA) Elvira Gonzalez and Licensing Program Manager (LPM) Stephanie Cifuentes conducted an unannounced annual required visit using the new CARE Inspection Tool. LPA met with administrator Gary Strathearn and explained the purpose of today’s visit and was granted entrance. The facility is licensed for (4) four ambulatory residents, of which 2 may be non-ambulatory. Facility has a hospice waiver for three (3). Currently, there are 3 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: 3 resident bedrooms, two (2) bathrooms, sofa, and kitchenette. There is an adjacent enclosed patio/activity room area.

LPA, LPM and staff 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 clean and operational.

LPA reviewed (2) staff files, (1) client files.

An Annual inspection continuation will be conducted a later date.

No deficiencies were cited during this inspection visit.

An exit interview was conducted and a printed copy of this report was provided to Gary Strathearn
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Elvira GonzalezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2023
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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