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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320105
Report Date: 07/26/2023
Date Signed: 07/27/2023 03:45:11 PM


Document Has Been Signed on 07/27/2023 03:45 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:AVIATION GUEST HOMEFACILITY NUMBER:
198320105
ADMINISTRATOR:GALLIOS, WILLIAM V. IIFACILITY TYPE:
740
ADDRESS:317 S. AVIATION BLVDTELEPHONE:
(310) 533-1131
CITY:MANHATTAN BEACHSTATE: CAZIP CODE:
90266
CAPACITY:6CENSUS: 4DATE:
07/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:47 AM
MET WITH:House manager Gat Magtanggol DilagTIME COMPLETED:
01:15 PM
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On 07/26/23, Licensing Program Analyst (LPA) Lizeth Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with house manager Gat Magtanggol Dilag as the purpose of today’s visit was explained. The facility is licensed for six (6) non-ambulatory elderly adults ages 60 and over of which one (1) may be bedridden and have an approved hospice waiver for four (4).

The facility is a single-story structure located in a residential neighborhood on a main street. It consists of the following: 4 bedrooms, 2 bathrooms, family room/dining room, staff work area, kitchen, living room, shaded area, indoor and outdoor area, laundry room and an attached garage. LPA and staff toured the physical plant. There are no bodies of water or firearm/ammunition on the premises. All residents rooms were checked. Beds and bedding were in good condition, adequate lighting provided. Residents rooms, walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 112.9. F and 114 F. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were inaccessible to clients. The kitchen was inspected and there is a enough perishable and non-perishable food available which is stored properly. Fire extinguisher was charged, smoke detectors and Carbon Monoxide were operable. Last time the LAFD came out was on 06/02/23. . Exits/ Walkways around the facility were free of debris and hazards.



During today’s visit no discrepancies were cited.

Exit interview conducted with House manager Gat Magtanggol Dila, and a copy of this report was provided.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Lizeth VillegasTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2023
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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