198200623-9-13-2024-11-AS-TWAN-D93RJX-20240913130439

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198200623
Report Date: 09/13/2024
Date Signed: 09/13/2024 01:04:44 PM

Document Has Been Signed on 09/13/2024 01:04 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:	DEWEY HOME INC.		FACILITY NUMBER:	198200623
ADMINISTRATOR:	RAFAEL BRAVO		FACILITY TYPE:	740
ADDRESS:	2127 DEWEY STREET		TELEPHONE:	(310) 458-8006
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90405
CAPACITY:	6	CENSUS: 0	DATE:	09/13/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Ivan Bravo - Administrator		TIME COMPLETED:	01:10 PM

NARRATIVE

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Licensing Program Analyst (LPA) Troy Watson conducted an unannounced visit to Dewey Home Inc. on 09/13/2024 at 08:50 AM. The LPA met with the Administrator Ivan Bravo and the purpose of the visit was explained. The facility is licensed to serve 6 non-ambulatory residents and currently has a census of (0). Hospice waiver for 3 residents. The facility does not handle any of the resident’s money.This home is a one story home consisting of: (4) resident bedrooms, (4) bathrooms, (1) living room, (1) kitchen with a dining room, and laundry area (located in the back of the facility a shaded patio area located outside the facility in the front of the house. The resident’s bedrooms had the required furniture, lamps, adequate bed linen and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked and found to be sanitary and within Title 22 regulations. Toilets flushed and water faucets worked properly, grab bars were secure, showers were free of mold and mildew. The water temperature measured between 108 F and 109.F in each bathroom and in the kitchen. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas such as the dining room and living room 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 supplies were checked and adequately stocked. All cleaning solutions, hazardous items, and medications were in a securely locked space that will be inaccessible to residents. Eight smoke detectors/ carbon monoxide detectors worked properly. The residence has (3) fire extinguishers that was inspected on 10/03/23 and are fully charged. The First Aid kits were checked and properly stocked with scissors, tape, gauze, and certified manual. No bodies of water were observed around the facility. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises.

An exit interview was conducted, and a copy of this report was provided to the Administrator Ivan Bravo.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (424) 544-1088
LICENSING EVALUATOR NAME: Troy Watson	TELEPHONE: (424) 544-1069
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024

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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