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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198203965
Report Date: 07/05/2022
Date Signed: 07/06/2022 08:26:05 AM


Document Has Been Signed on 07/06/2022 08:26 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
MONTEREY PARK, CA 91754



FACILITY NAME:VILLA CHRISTAFACILITY NUMBER:
198203965
ADMINISTRATOR:ARLENE FELICIANOFACILITY TYPE:
740
ADDRESS:16421 CHANERA AVETELEPHONE:
(310) 719-8997
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY:6CENSUS: 5DATE:
07/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Maria Torres House MgrTIME COMPLETED:
04:36 PM
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Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced Annual required and infection control visit to the above facility. LPA was met by Maria Torres House Mgr House Manager and later met with Arlene Feliciano, administrator and the purpose of today’s visit was explained.There are currently (5) residents in the facility. (2) residents are ambulatory and (3) are non-ambulatory. The facility is a single story structure located in a residential neighborhood. It consists (6) bedrooms, (2) full bathrooms, there is one shared bedroom #5, shaded back yard, front yard, laundry room and a detached 2 garageLPA and Arlene Feliciano, administrator toured the entire facility inside and out. Documents are posted as mandated. Bedrooms 1-5 are occupied by residents and contain the mandated furniture. Bedroom 6 is a staff bedroom. The (2) bathrooms are clean and operational. First aid kit is fully stocked with manual, smoke detectors and carbon monoxide detector were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. Residents Medications and file were viewed. Staff file is current. Ample supply of perishable and nonperishable food, hot water temperature is 112 degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, 1 fire extinguisher is fully charged, fire drill conducted on 03/2021. First Aid kit complete and with Manual. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair. During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry, visitors are logged and temperature checked, sanitizer/soap in the staff bathroom and additional sanitation supplies are locked in the garage. LPA observed staff and residents wearing masks, resident private rooms will be converted to isolation rooms (if needed) and required postings throughout the facility. The resident’s temperatures are checked and logged once a day. PPE's are enough for 30 days. Administrator states that she According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time.

An exit interview conducted with Arlene Feliciano, Administrator and copy of report provided.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 395-3554
LICENSING EVALUATOR NAME: Jeremiah RandleTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 07/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/05/2022
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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