<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197803692
Report Date: 08/14/2023
Date Signed: 08/15/2023 08:27:09 AM

Document Has Been Signed on 08/15/2023 08:27 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:BETTER LIVING HAVEN OF GARDENIAFACILITY NUMBER:
197803692
ADMINISTRATOR:ZARAGOZA, ERLYN R.FACILITY TYPE:
735
ADDRESS:5920 GARDENIA AVENUETELEPHONE:
(562) 423-0775
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 4CENSUS: 3DATE:
08/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:48 PM
MET WITH:Acting Administrator Nestor ZaragozaTIME COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
 On 08/14/2023 Licensing Program Analyst (LPA) Lizeth Villegas conducted an unannounced annual required visit using the new CARE Inspection Tool. LPA met with acting Administrator Nestor Zaragoza as the purpose of today’s visit was explained. The facility is licensed to operate for four(4) Developmentally disabled Ambulatory only adults ages 18 through 59. The residents are Harbor Regional Center consumers.

The facility is a one story structure located in a residential neighborhood. It consists of the following: four (4) resident's rooms, two(2) staff bedrooms, two (2) common bathrooms, living area, dining area, kitchen, patio area and an attached garage that serves as an administrative office and laundry room. The facility has a working landline throughout the facility. .

LPA toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for client personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were operational. The water temperature measured 110.9. A comfortable temperature of 74 degrees was maintained in the facility.

LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available. Fire extinguishers were charged, smoke detectors and carbon monoxide were operable. A review of 1 resident file, 1 staff file, 1 P&1 ledger, 1 the Medication Records Administration (MAR), and Fire/Disaster Drills were found to be complete and accurate. Exits/ Walkways around the facility were free of debris and hazards. During today’s visit no discrepancies were cited. Exit interview conducted with acting Administrator Nestor Zaragoza, and a copy of this report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1