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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198202296
Report Date: 11/30/2022
Date Signed: 01/06/2023 04:11:22 PM

Document Has Been Signed on 01/06/2023 04:11 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, 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: DATE:
11/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Wendy Gibbs made an unannounced annual visit using the CARE tools. LPA Gibbs met with administrator, Sara Binmoeller and explained the purpose of today’s visit. There are currently 5 residents in the facility.

Structure The home consists of 7 bedrooms and 4 bathrooms. On the first floor there are 3 resident bedrooms, 3 bathrooms (2 full baths), living room, sitting room, dining room, kitchen, laundry room, and attached garage. On the second floor there are 4 bedrooms, and bathroom.

Physical Plant Outside grounds were toured. There is ample seating and a table with an umbrella. Walkways around the home were clear of hazards. There was a fountain in the backyard inaccessible to residents. There are no security bars or weapons on the premises.

Bedroom Resident bedrooms had the required furniture, including beds, nightstands, dressers, and chairs. There is ample closet space and lighting. Each bed had the necessary linens including mattress cover, fitted sheets, blanket, comforter and pillow.

Linens & Hygiene There were additional linens and towels in the closets and personal need items such as diapers and mats. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked.

Bathrooms 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 and chair was in place. Water temperature measured between 116.5- and 118.4-degrees Fahrenheit.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2022
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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: ELEANOR'S RESIDENTIAL HOME
FACILITY NUMBER: 198202296
VISIT DATE: 11/30/2022
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Kitchen All appliances were in good working condition. LPA observed a 3-day supply of perishable foods and a 14-day supply of nonperishable foods. In the garage there are 2 additional refrigerators and a freezer as well as shelves full of canned goods. There is a large supply of water. All cutleries were in good condition. Knives were locked in a cabinet in the kitchen. The water temperature measured 118.6

Common areas were clean and clear of hazards; doorways were free of obstructions. LPA observed activities and games available for residents.

Laundry room is inaccessible to residents. All cleaning solutions, and hazardous items are stored and locked away.

Files LPA reviewed all resident files, which included all required documentation. LPA also reviewed all staff files, which included all required documentation and verification of training.

Medications LPA reviewed medications and MARs. The medications were securely locked and inaccessible to residents.

Safety Smoke/Carbon Monoxide detectors were working properly. LPA observed 3 fire extinguisher, fully charged and serviced on 11/17/22. LPA inspected First Aid kit with manual. Doors were equipped with functioning egress sensors. All necessary signs and exits were posted.

Infection Control 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’s temperature was checked by the facility administrator and logged. LPA observed staff wearing mask and was given foot covers at the entry. All required postings are throughout the facility.

LPA reviewed the Liability Insurance. The facility does not handle residents’ cash.

No deficiencies cited:

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

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022
LIC809 (FAS) - (06/04)
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