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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320161
Report Date: 02/18/2022
Date Signed: 02/18/2022 02:04:52 PM

Document Has Been Signed on 02/18/2022 02:04 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME:DENVER RESIDENTIAL FACILITY, INC DBA DENVER RESIDFACILITY NUMBER:
198320161
ADMINISTRATOR:ALLEN, LYNN TIFACILITY TYPE:
735
ADDRESS:14410 S DENVER AVETELEPHONE:
(810) 756-3839
CITY:GARDENASTATE: CAZIP CODE:
90248
CAPACITY: 4CENSUS: DATE:
02/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Jeanette KiddTIME COMPLETED:
02:15 PM
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 On 2/1822, Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA spoke with Administrator Jeanette Kidd to conduct the covid-19 screener questionnaire and was informed the facility is free of Covid-19. LPA was met by Brenda Nelson and explained the purpose of today’s visit is the annual visit concentrating on Infection control measure and was allowed entry into the facility. The facility is an Adult Residential Facility serving Developmentally Disabled Adults for ages 18 to 59 years. The requested capacity is for 4 clients, 4 non-ambulatory, no ambulatory. Facility has a fire clearance for 4 non-ambulatory clients only.

Facility is a 4 client-bedroom, 1 office, 2 bathroom, one-story house. The client bedrooms are spacious and easily accommodate the client's furnishings. There is a back yard with a shaded patio area and chairs. Shaded area has sufficient tables and chairs for clients. Outdoor passageways, walkways, driveways, steps and patios are free from obstructions.

LPA and staff toured the physical plant. There were no bodies of water or obstructions on the premises. Beds and bedding supplies were in good condition, adequate lighting provided, storage for client personal belongings was observed. 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.

LPA observed the facility to be sanitary and appropriately furnished at the time of visit. The kitchen was inspected and there is a 2-day supply of perishable and a 7-day supply of non-perishable food available, maintained properly. One fully charged fire extinguishers was found in kitchen.

During the visit, LPA observed the facility infection control practices. LPA observed screening protocol for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings, a 30-day supply of Personal Protective Equipment (PPE) is available and sign in and out logs for visitors and staff are present in the facility.

There were no deficiencies cited or technical advisories given during this visit

An exit interview was conducted, and a copy of this report was provided to Jeanette Kidd.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2022
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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