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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609367
Report Date: 08/31/2023
Date Signed: 08/31/2023 04:05:39 PM


Document Has Been Signed on 08/31/2023 04:05 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 4FACILITY NUMBER:
197609367
ADMINISTRATOR:GARY STRATHEARNFACILITY TYPE:
740
ADDRESS:910 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:
12:38 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) non-ambulatory residents. Facility has a hospice waiver for three (3). Currently, there are 3 residents, all are over the age of 60..

LPA reviewed (2) staff files and (1) client file.

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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