198204848-1-31-2025-11-AS-DLEE-DDFU9T-20250131142339

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198204848
Report Date: 01/31/2025
Date Signed: 01/31/2025 02:23:50 PM

Document Has Been Signed on 01/31/2025 02:23 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:	PLD FAMILY HOME CARE		FACILITY NUMBER:	198204848
ADMINISTRATOR/ DIRECTOR:	PRECIOUS DENNIS		FACILITY TYPE:	740
ADDRESS:	139 WEST ELLIS AVENUE		TELEPHONE:	(310) 419-5829
CITY:	INGLEWOOD	STATE: CA	ZIP CODE:	90302
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 6	DATE:	01/31/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:03 PM
MET WITH:	Precious Dennis		TIME VISIT/ INSPECTION COMPLETED:	02:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On January 31, 2025, Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced required annual visit using the CARE Inspection Tools. LPAs met with Precious Dennis and explained the purpose of this visit. The facility is licensed for (6) 60-year-old or older adults. May retain 1 hospice resident . Currently, there are 6 residents in the facility. The facility is a single-story home located in a residential neighborhood. LPA Lee and Administrator Ms. Dennis toured the facility which consisted of the following: A living room, four (4) bedrooms, two (2) bathrooms, one (1) half-bathroom, dining room, kitchen, laundry area, detached garage, shaded area, indoor/outdoor activity areas. Physical Plant LPA and Administrator Louretta Dennis toured the facility inside and outside. LPA observed There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the resident's personal belongings was observed. LPA observed that facility had required postings: Facility license, personal rights, ombudsman information poster, facility sketch, exit signs, infectious disease postings, Administrator certificates, an emergency disaster plan. Page 1 of 2

Eva M Alvarez	TELEPHONE: (323) 629-7047
Deborah Lee	TELEPHONE: (424) 544-1051
	DATE: 01/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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: PLD FAMILY HOME CARE	FACILITY NUMBER: 198204848
	VISIT DATE: 01/31/2025

NARRATIVE

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Bedrooms LPA inspected all (4) bedrooms (2 private 2 shared) All bedrooms were observed to have the required furniture including beds, dressers, night stands with lamps, chairs, and ample storage space for personal belongings. All bedrooms were observed to be clean, in good repair, and have ample lighting.

Bathrooms LPA inspected the facility bathrooms. In the resident’s bathroom the toilet, faucets, and shower were fully operational. All safety handrails were securely fastened. LPA observed the showers to be clean and free of mold or mildew. The shower had a nonskid material in bottom and shower chair. Resident’s toiletries and incontinent supplies observed in resident rooms. The water temperature measured 110 degrees Fahrenheit. All bathrooms were observed to be clean, in good repair and within Title 22 regulations.

Linens & Hygiene LPA observed all beds to have the required linens including mattress cover, fitted sheets, blanket, comforter, and pillow. LPA observed an ample supply of linens, towels, and blankets in hall closet. .

Kitchen LPA inspected the kitchen and observed all appliances to be in good working repair, including stove/oven, microwave, dishwasher, refrigerator. LPA observed an ample supply of cutlery, pots, pans, and bowls to be in good repair. LPA observed knives and additional sharps to be secured in locked cabinet in the kitchen and are inaccessible to residents. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods. There is a laundry room where the washer and dryer are located. The detergent and other cleaning supplies are locked in a cabinet inaccessible to residents in care.

Due to time restraint, LPA to complete inspection on subsequent visit. There were no deficiencies cited during this visit. Exit interviewed conducted and copy of report provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Deborah Lee	TELEPHONE: (424) 544-1051
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025

LIC809 (FAS) - (06/04)

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