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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198205144
Report Date: 12/21/2023
Date Signed: 12/21/2023 03:16:03 PM


Document Has Been Signed on 12/21/2023 03:16 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:SANTA FE HOME CARE HOMESFACILITY NUMBER:
198205144
ADMINISTRATOR:ANGELIQUE GRADNEYFACILITY TYPE:
740
ADDRESS:2340 SANTA FE AVENUETELEPHONE:
(424) 488-2079
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY:6CENSUS: 4DATE:
12/21/2023
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Ray Malit - House Manager/CaregiverTIME COMPLETED:
03:30 PM
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On 12/21/2023 at around 8:10 AM, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with the House Manager / Caregiver Rey Malit. LPA explained the purpose of the visit and was accompanied by the House Manager inside and outside the facility during this inspection.

This facility is licensed to serve 6 adults ages 60 and above, of which 2 may be non-ambulatory residents.
Rooms 1 & 4 are for ambulatory residents.
Rooms 2 & 3 are for non-ambulatory residents.

A total of 4 residents are currently residing in this facility, of which 2 are ambulatory, 1 is non-ambulatory, and 1 is bedridden.

The Annual Licensing Fees are current.

The facility is a one story house located in a residential street.
The home consists of 4 resident bedrooms, 2 staff bedrooms, 1 ensuite bedroom (bedroom is connected to its own bathroom and a non-staff member is currently residing in the bedroom), 1 bathroom, 1 toilet room, 1 living room, 1 kitchen/dining/tv room, 1 attached garage, front and backyard patio areas have shaded seating.
The home has a total of 7 bedrooms and 2 full bathrooms.

Due to time constraints the LPA was unable to complete todays visit.

An exit interview was conducted and a copy of this report was left with the House Manager.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro LeandroTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2023
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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