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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320083
Report Date: 07/18/2024
Date Signed: 07/18/2024 12:51:50 PM

Document Has Been Signed on 07/18/2024 12:51 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:DUPE HOME CARE SERVICESFACILITY NUMBER:
198320083
ADMINISTRATOR/
DIRECTOR:		MORGAN, DEBORAHFACILITY TYPE:
735
ADDRESS:5879 & 5881 ESTRELLA AVETELEPHONE:
(323) 291-1355
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY: 12CENSUS: 11DATE:
07/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:23 AM
MET WITH:Donna Kaye Eko - Licensee and Marty Eko - Assistant AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:55 PM
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On 07/18/2024 at 8:23 AM Licensing Program Analyst (LPA) Troy Watson conducted an unannounced annual required visit. LPA met with the Licensee and Administrators Donna Eko and Marty Eko and the purpose of today’s visit was explained. The facility is licensed to operate for (12) developmentally disabled or mentally ill adults ages 18 - 59. Currently the home has (11) clients.

The facility is a two story structure located in a residential neighborhood and consists of the following: (5) client bedrooms, (3) common bathrooms, (2) living room areas, (2) dining areas, (2) kitchens, an outside patio area and a front porch area.

LPA Troy Watson and Administrator Marty Eko toured the inside and outside of the facility. All client rooms were checked. Mattresses and box springs were in good condition, adequate lighting was observed, plenty of dresser chairs and closet space was observed.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2024
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 3
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: DUPE HOME CARE SERVICES
FACILITY NUMBER: 198320083
VISIT DATE: 07/18/2024
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Bed linens, comforters and bath towels were adequately stocked at the time of visit. The bathrooms were found to be within Title 22 regulations. Toilets and water faucets worked properly. The shower was free of mold/mildew. There is adequate lighting, and sufficient toiletries are accessible to clients. The water temperature properly measured between 107.F – 109.F bathrooms and in the Kitchen.

Evaluation Report continues LIC 809-C

LPA Troy Watson observed the facility clean, sanitary, and appropriately furnished at the time of the visit. The kitchen, refrigerators and deep freezer was fully stocked with food. The administrator has (10) Carbon monoxide / smoke detectors that have been tested and are operational. Two fire extinguishers were checked, and they were fully charged and dated 09/27/2023. Toxins and knives were locked and inaccessible to clients. Medications were inspected and accounted for at the time of inspection. The first aid kit was checked and fully stocked with a certified manual.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: DUPE HOME CARE SERVICES
FACILITY NUMBER: 198320083
VISIT DATE: 07/18/2024
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LPA reviewed the facility disaster plan. The facility disaster plan was current and in compliance with Title 22 at the time of visit. Staff records and P&I were presently available for immediate review and inspection.

An exit interview was conducted, with the administrator and a copy of this report was provided.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC809 (FAS) - (06/04)
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