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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320129
Report Date: 01/13/2024
Date Signed: 01/13/2024 12:16:44 PM


Document Has Been Signed on 01/13/2024 12:16 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245



FACILITY NAME:CASA DE ESTRELLAFACILITY NUMBER:
198320129
ADMINISTRATOR:BUSTOS, GLENDAFACILITY TYPE:
740
ADDRESS:22313 MADISON STREETTELEPHONE:
(310) 504-0648
CITY:TORRANCESTATE: CAZIP CODE:
90505
CAPACITY:6CENSUS: 6DATE:
01/13/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:MELANIE TALLADATIME COMPLETED:
12:30 PM
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On 01/13/2024, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA met with two caregivers (S1 and S2) and explained the purpose of today’s visit. LPA Richard later was joined by Administrator assistant Melanie Tallada.

The facility is licensed to operate for six (6) elderly residents ages 60 and above. The facility is approved for six (6) Non ambulatory of which one (1) may be bedridden and two (2) can be under hospice care.

The facility is a single-story structure located in a residential neighborhood. The facility consists of the following: five (5) resident bedrooms, three (3) bathrooms of which one (1) is designated for staff only, a living room area, a dining area, kitchen, receiving or visitation room and an attached garage used for storage only. The washer and dryer are stacked and located in the kitchen and there is a second refrigerator/freezer in the garage.

LPA Richard and house manager Barnum toured the inside and outside grounds of the physical plant. There are no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Bathrooms were found to be within Title 22 regulations and were clean and operational. A comfortable temperature was maintained in the facility.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonine RichardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 01/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2024
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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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: CASA DE ESTRELLA
FACILITY NUMBER: 198320129
VISIT DATE: 01/13/2024
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LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, and toxins were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. There are two (2) fire extinguishers fully charged in the kitchen and the garage. First aid kit was located in the kitchen. Smoke detectors and carbon monoxide were operable.

During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed six (6) residents and two (2) staff present during the tour. All mandated inspection control posters were posted.

An exit interview was conducted, and a copy of this report was provided to Administrator assistant Melanie Tallada.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonine RichardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2