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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609366
Report Date: 09/18/2024
Date Signed: 09/18/2024 11:58:41 AM


Document Has Been Signed on 09/18/2024 11:58 AM - 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 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:
09/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:12 AM
MET WITH:Jennifer Block, Asst AdministratorTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one-year inspection. LPA met with Jennifer Block , Administrator and the purpose of the visit was discussed. Facility is licensed to serve 4 ambulatory residents and an approved hospice waiver for 3 residents. Two (2) of the residents may be non ambulatory. Currently One (1 )resident is on hospice and One (1) resident is receiving home health services. The facility does not handle any of the residents’ money.

This home is a single story home consisting of: (3) resident bedrooms, (2) bathrooms, sofa and kitchenette. There is an adjacent enclosed patio/activity room area, laundry room (located in the attached garage) and an outdoor shaded patio area. LPA toured the Resident bedrooms which had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured between 118.1F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions.

Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises.

During todays visit LPA did not observe any deficiencies.

An Exit interview was conducted with Jennifer Block, Asst Administrator. and a copy of this report was provided.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Sparkle DayTELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2024
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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