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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198202296
Report Date: 06/27/2024
Date Signed: 06/27/2024 02:35:08 PM


Document Has Been Signed on 06/27/2024 02:35 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: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: 5DATE:
06/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:53 AM
MET WITH:Sara Binmoeller AdministratorTIME COMPLETED:
03:15 PM
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On 06/27/24 at 11:53 am, Licensing Program Analyst (LPA), David España conducted an unannounced annual visit using the full CAREs tool. Upon arrival at the facility, LPA España conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection. LPA verified that the facility has an approved mitigation plan report. LPA was granted access and allowed to enter the facility to conduct the inspection. LPA was met by Sara Binmoeller; Administrator and the purpose of today’s visit was explained. The facility is licensed for 5 non-ambulatory residents and 1 ambulatory resident. The facility currently has 1 ambulatory resident and 4 non-ambulatory residents. The facility has a total of five (5) residents in care. The facility does not handle any of the residents’ money. LPA toured the physical plant, checked food service, reviewed staff records and reviewed resident files for medical status. The facility conducted a fire drill on 1/27/2024. The home consists of 4 resident bedrooms, 3 bathrooms, living room, dining room, Television/Activity room, kitchen and attached garage. 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 Title 22 regulations.
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: ELEANOR'S RESIDENTIAL HOME
FACILITY NUMBER: 198202296
VISIT DATE: 06/27/2024
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 Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas 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 supply was checked. All medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguishers were fully charged. Carbon monoxide detector were operational. First Aid kit and manual was available. 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.

There were no deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8.

An exit interview was conducted with Sara Binmoeller, Administrator and copy of report provided.


SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4