198204545-10-30-2023-11-AS-RCLD-CX4VNX-20231030163552

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198204545
Report Date: 10/30/2023
Date Signed: 10/30/2023 04:36:13 PM

Document Has Been Signed on 10/30/2023 04:36 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	SIMLA VILLAS, REDONDO BEACH		FACILITY NUMBER:	198204545
ADMINISTRATOR:	SIMLA MEHTA		FACILITY TYPE:	740
ADDRESS:	2805 ROBINSON STREET		TELEPHONE:	(310) 483-6965
CITY:	REDONDO BEACH	STATE: CA	ZIP CODE:	90278
CAPACITY: 6		CENSUS: 5	DATE:	10/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:59 PM
MET WITH:	Jennifer Bobadilla		TIME COMPLETED:	04:45 PM

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On 10/30/2023 at 1:00 PM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Jennifer Bobadilla, Administrator. Five (5) residents and two (2) staff were present during this inspection.

Facility is licensed to serve six (6) non-ambulatory residents. The facility currently has 5 non-ambulatory residents.

The facility is a two-story structure located in a residential neighborhood. It has a ramp going alongside front of home. The 1st floor is the facility and 2nd floor is for staff. 1st floor It consists (6) bedrooms, (3) full bathrooms, 1/2 bathroom. Sun room, book/activities area, living room/office area, dining room, kitchen/office area, ramp alongside of living room & dining room also ramp alongside of hallway to bedrooms, shaded back yard, front yard, gazebo, laundry room and 2 car garage.

Staff accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards.

Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises.

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. Resident bath towels and toiletries were adequately stocked.

Common areas were clean and clear of hazards, doorways were free of obstructions.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SIMLA VILLAS, REDONDO BEACH	FACILITY NUMBER: 198204545
	VISIT DATE: 10/30/2023

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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. Knives and toxics were kept in locked storage cabinet. First Aid kit was available. LPA observed one fire extinguisher last serviced August 16, 2023.

5 staff records were reviewed, 5 out of 5 staff records had required criminal record clearances. 2 staff were interviewed.

5 resident records were reviewed and, 5 out of 5 resident records had Admission Agreements, Medical Assessments, and Needs & Services Plans. 3 resident medication records were reviewed. 2 residents were interviewed.

Deficiencies are not being cited based on LPA observation, interviews conducted and record review in accordance with the California Code of Regulations, Title 22.

An exit interview was conducted. A copy of this report was left with the Administrator.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

LIC809 (FAS) - (06/04)

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