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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198202296
Report Date: 06/04/2021
Date Signed: 06/04/2021 02:36:24 PM

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
MONTEREY PARK, CA 91754
FACILITY NAME:ELEANOR'S RESIDENTIAL HOMEFACILITY NUMBER:
198202296
ADMINISTRATOR:BINMOELLER, SARA R.C.FACILITY TYPE:
740
ADDRESS:4926 SHENANDOAH AVETELEPHONE:
(310) 216-9422
CITY:LOS ANGELESSTATE: CAZIP CODE:
90056
CAPACITY:6CENSUS: 6DATE:
06/04/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Sara Binmoeller, Licensee TIME COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA) Jennifer Jones conducted an unannounced visit to Eleanor's Residential Home. The purpose of today’s visit was to conduct an annual inspection. LPA Jones was greeted by the administrator, Sara Binmoeller and staff, Rene Delgadillo. The facility is licensed for 5 non-ambulatory residents on the first floor, 1 ambulatory on the second floor. 0 bedridden residents. The facility also has an approved hospice waiver for 5 residents and a dementia waiver on file. The facility currently has 3 ambulatory residents and 3 non-ambulatory residents. Some of the residents are diagnosed with Dementia. Some are currently are receiving home health or hospice services. The facility does not handle any of the residents’ money.

LPA Jones and the administrator toured the physical plant inside and outside. LPA observed a medical doctor at the facility meeting with residents in care. LPA observed families visiting with residents inside and outside of the facility. LPA observed non perishable food items and over a two week supply of perishable/frozen food. LPA Jones reviewed a staff record and resident file for medical status. The home consists of 7 bedrooms and 4 bathrooms. 3 resident bedrooms and 2 resident bathrooms downstairs. 1 staff bedroom, 3 resident bedrooms, 1 staff bathroom upstairs, living room, dining room, and kitchen. 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 a non-skid mat was in place. Water temperature measured between 105-120 degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions.

SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jennifer JonesTELEPHONE: (323) 518-3833
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2021
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
MONTEREY PARK, CA 91754
FACILITY NAME: ELEANOR'S RESIDENTIAL HOME
FACILITY NUMBER: 198202296
VISIT DATE: 06/04/2021
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All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly and fire extinguisher was fully charged. Carbon monoxide detector was operational. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises.

During the visit, LPA observed the facility infection control practices. LPA observed a screening station with sanitizer/soap in the facility and additional sanitation supplies in the garage inaccessible to the clients. LPA observed a sign in sheet and temperature log for visitors. LPA observed the facility administrator check in visitors and screening process. LPA observed staff wearing mask and was given foot covers at the entry. Each client has their own individual room for isolation and required postings are throughout the facility. The administrator advised LPA that visitors have the option to meet with the clients inside or outside by appointment only.

No deficiencies cited:

Exit interview conducted and a copy of report was given to the administrator.

SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jennifer JonesTELEPHONE: (323) 518-3833
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2021
LIC809 (FAS) - (06/04)
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