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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320161
Report Date: 02/23/2024
Date Signed: 02/23/2024 12:25:20 PM

Document Has Been Signed on 02/23/2024 12:25 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: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: 3DATE:
02/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Jeanette KiddTIME COMPLETED:
12:30 PM
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On 2/23/24, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced annual required visit using the new CARE Inspection Tool. LPA met with Administrator Jeanette Kidd and explained the purpose of today’s visit. The facility is an Adult Residential Facility serving Developmentally Disabled Adults for ages 18 to 59 years. The requested capacity is for four (4) clients, four (4) non-ambulatory, no ambulatory. Currently there are three (3) clients in placement.

The facility is a single-story structure located in a residential neighborhood. It consists of four (4) bedrooms, two (2) bathrooms, a family room/dining area, kitchen, living room, laundry area, and an outside shaded area.

LPA Gonzalez and Administrator toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was 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. The water temperature measured 117.9 F in bathroom #1 and 113.1 F in bathroom #2. A comfortable temperature was maintained in the facility.



LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharp objects were stored and not accessible to clients. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. A fire extinguisher was charged, smoke detectors and carbon monoxide were operable. A landline telephone was connected. A review of the Medication Administration Records was accurate and in order.

Continued on LIC 809-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2024
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: DENVER RESIDENTIAL FACILITY, INC DBA DENVER RESID
FACILITY NUMBER: 198320161
VISIT DATE: 02/23/2024
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During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has a Mitigation Plan Report on file with CCLD.


No deficiencies or advisories were cited during this inspection visit.

An exit interview was conducted, and a copy of this report was provided to Jeanette Kidd, Administrator.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
LIC809 (FAS) - (06/04)
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