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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609366
Report Date: 09/01/2023
Date Signed: 09/01/2023 02:40:53 PM


Document Has Been Signed on 09/01/2023 02:40 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:
09/01/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
12:29 PM
MET WITH:Gary StrathearnTIME COMPLETED:
02:45 PM
NARRATIVE
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On 9/1/2023, Licensing Program Analyst (LPA) Elvira Gonzalez and Licensing Program Manager (LPM) Stephanie Cifuentes conducted an unannounced continued 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.

During today's visit, LPA Gonzalez completed the CARE Inspection tool.

Documents are posted as mandated. The following Title 22 regulated areas were audited and found to be in compliance: Bedrooms contain the required furniture. First aid kit is fully stocked with manual, working telephone, the fire extinguisher is fully charged, medications were centrally stored and properly locked, ample supply of perishable and nonperishable food, adequate lights and linen supply. No firearms on the premises, all exit doors were in compliance, covered trash cans, and no bodies of water were present. Hazardous items are inaccessible to residents, the yard is free of debris and hazards.

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: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2023
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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