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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198204836
Report Date: 12/27/2023
Date Signed: 12/27/2023 01:29:35 PM

Document Has Been Signed on 12/27/2023 01:29 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:OCEAN FRONT CARE HOMEFACILITY NUMBER:
198204836
ADMINISTRATOR:RODRIGO RAMOSFACILITY TYPE:
740
ADDRESS:3605 S. CAROLINA STREETTELEPHONE:
(818) 621-3232
CITY:SAN PEDROSTATE: CAZIP CODE:
90731
CAPACITY: 6CENSUS: 3DATE:
12/27/2023
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:17 AM
MET WITH:Administrator Rodrigo RamosTIME COMPLETED:
01:45 PM
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On 12/27/2023 at 9:17 AM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced Required – Annual Inspection and met with Sheryl Menor. Administrator Rodrigo Ramos joined us 30 minutes later. Three (3) residents and two (2) staff were present during this inspection.

Facility is licensed to serve 6 non-ambulatory and may retain four (4) hospice resident age 60 and above.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) residents' rooms, three (3) common bathrooms one (1) staff bathroom with en-suite bath, a living area, a dining area, a kitchen, and an outside enclosed laundry area.

Sheryl 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, hot water temperature properly measured 119F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked.

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

Continue to LIC 809-C.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 3 of 13
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: OCEAN FRONT CARE HOME
FACILITY NUMBER: 198204836
VISIT DATE: 12/27/2023
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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 locked. First Aid kit was available and stocked. One fire extinguisher, last serviced June 6, 2023 was observed in the kitchen area. LPA tested carbon monoxide detectors and smoke detector located in the kitchen area. Both devices were functional.

5 staff records were reviewed, 5 out of 5 staff records had required criminal record clearances or criminal record exemptions. Two staff interviews were conducted.

3 resident records were reviewed and, 3 out of 3 client records had Medical Assessments. Two residents’ medication was reviewed.

No deficiencies are being cited.

An exit interview was conducted and technical assistance provided. A copy of this report was discussed and left with the Administrator.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023
LIC809 (FAS) - (06/04)
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