198320161-2-5-2025-11-AS-FSHY-DDLRU8-20250205121932

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320161
Report Date: 02/05/2025
Date Signed: 02/05/2025 05:52:34 PM

Document Has Been Signed on 02/05/2025 05:52 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 RESID		FACILITY NUMBER:	198320161
ADMINISTRATOR/ DIRECTOR:	ALLEN, LYNN TI		FACILITY TYPE:	735
ADDRESS:	14410 S DENVER AVE		TELEPHONE:	(810) 756-3839
CITY:	GARDENA	STATE: CA	ZIP CODE:	90248
CAPACITY: 4		CENSUS: 4	DATE:	02/05/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:03 AM
MET WITH:	Jeanette Kidd, Administrator		TIME VISIT/ INSPECTION COMPLETED:	12:20 PM

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On 2/5/25, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced required annual visit using the full CAREs Inspection Tool. LPA met with the Administrator, Jeanette Kidd and explained the purpose of today’s visit. The facility is licensed to serve adult developmentally disabled residents ages 18 thru 59 years old.

LPA reviewed all resident files and found that they did contain all required documents. LPA reviewed six (6) staff files and found they did contain all required documents, training, and certification. LPA Shirley reviewed all residents MAR and medications. During file review, LPA observed the surety bond.

LPA Felisa and staff, Brenda toured both inside and outside of the facility. The facility is a one-story structure located in a residential neighborhood. The facility consists of (4) client bedrooms (1) office, (2) bathrooms, living room, kitchen, and dining area. Facility maintains all required posting throughout the facility.

All bedrooms were toured. Bedrooms 1-4 are occupied by residents and contain the mandated furniture. LPA observed all rooms to have the required furniture including a bed, dresser(s), and chair(s). All beds had the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillow. LPA observed ample lighting in all the bedrooms.

LPA Shirley and Brenda toured the kitchen and found it to be clean and sanitary. All appliances were in good working order. Knives were locked and stored. The medications were locked and stored in the cabinet located in the kitchen. LPA observed a 3-day supply of perishable and a 7-day supply of nonperishable foods.

The (2) bathrooms are clean and operational. First aid kit is fully stocked with manual. No firearms are stored at facility. This facility is in good repair. The water delivered at 119.8 F.

Con'd on 809-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

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: 02/05/2025

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LPA Shirley and Brenda walked through all common areas. In the living room, kitchen, dining room there is ample seating and space for all residents. All rooms and walkways were clean, and clear of obstructions and hazards. All areas have ample lighting. All rooms, hallway, and living room have working smoke detectors. There is a charged fire extinguisher located in the living room and in the back lounge area. The backyard is clean and clear of obstructions and hazards, and there are no bodies of water present.

An exit interview was conducted, and a copy of this report was signed by and given to the Administrator, Jeanette Kidd.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

LIC809 (FAS) - (06/04)

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