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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198202126
Report Date: 02/27/2020
Date Signed: 02/02/2022 08:06:51 AM

Document Has Been Signed on 02/02/2022 08:06 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME:SOUTH CENTRAL RESIDENTIAL CARE NETWORK #2FACILITY NUMBER:
198202126
ADMINISTRATOR:THELMA WILLIAMSFACILITY TYPE:
740
ADDRESS:1551 W. 80TH STREETTELEPHONE:
(323) 233-3553
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY: 6CENSUS: DATE:
02/27/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Chiynera Offor-CaregiverTIME COMPLETED:
12:50 PM
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On 2/13/2020 at 10:50am, Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced annual inspection visit on the above-named facility. LPA was met at the door by staff member Chinyera Offor. LPA explained purpose of visit and staff member called administrator. LPA spoke to Administrator Thelma Williams via telephone and was allowed entry. Administrator Williams authorized Chinyera Offor to give LPA tour of facility and received report of today’s visit.

One (1) clients and one (1) staff were present in the facility during this inspection.

Facility is licensed for 6 residents, 4 ambulatory, 2 non-ambulatory, currently housing 3 residents. The Annual Licensing Fees are current.

The home consists of 1 floor: 3 resident rooms, 2 restrooms, kitchen, dining room, living room.

Staff member Chinyera accompanied LPA inside and outside the facility during this inspection.

Outside grounds were toured and no bodies of water were observed. Exits/walkways around the home were free of debris and hazards. Patio furniture under a shaded area at front of house was accessible to clients. There are no weapons on the premises. There were no security bars on the windows.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME: SOUTH CENTRAL RESIDENTIAL CARE NETWORK #2
FACILITY NUMBER: 198202126
VISIT DATE: 02/27/2020
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LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Water temperature in kitchen measured 119.6F

All three resident bedrooms 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 non-skid mats were in place. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Hot water temperature in bathroom 1 tested at 115.6F and 116.6F in bathroom 2.

Due to time constraints, LPA had to stop this annual inspection. A subsequent unannounced Case Management Annual Inspection will be conducted.

An exit interview was conducted. A copy of this report was discussed and left with administrator Chinyera Offor.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020
LIC809 (FAS) - (06/04)
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