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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197803288
Report Date: 07/26/2024
Date Signed: 07/26/2024 03:45:54 PM

Document Has Been Signed on 07/26/2024 03:45 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:RIDGEWOOD HOMEFACILITY NUMBER:
197803288
ADMINISTRATOR/
DIRECTOR:
EILEEN CORREOS-VAZQUEZFACILITY TYPE:
735
ADDRESS:1072 EAST RIDGEWOOD STREETTELEPHONE:
(562) 627-9612
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY: 4CENSUS: 3DATE:
07/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:22 PM
MET WITH:Eileen Correos Vazquez, AdminstratorTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 07/26/24 Licensing Program Analysts (LPAs) Villegas and Brown conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Eileen Correos Vazquez, Adminstrator as LPAs explained the purpose of today’s visit. The facility is licensed to operate for (4)developmentally disabled ambulatory adults ages 18 through 59. The clients are Harbor Regional Center consumers. Current facility census is (3), facility fees are current. Facility has a surety bond with exp. date of 03/15/26.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: (4) clients' rooms, two (2) bathrooms, a living area, a dining area, a kitchen, an outside patio area, an outdoor laundry area, and a detached garage that is used for storage and houses an additional refrigerator. There were no bodies of water, firearms, nor obstructions on the premises. LPAs observed the facility to be sanitary and appropriately furnished during the visit.

All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of the visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. A water temperature of 105 - 120 degrees F. Storage areas for personal hygiene, 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 and maintained adequately. The fire extinguishers were charged, and smoke detectors and carbon monoxide were operable. LPAs conducted a review of (3) client files, (2) staff files, (3) P&I's and a review of Medication Records Administration (MAR). No discrepancies observed. The last Fire Drills was conducted on 06/01/24. The facility has a working landline and internet service.

Exit interview conducted, and a copy of this report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2024
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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