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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320164
Report Date: 06/22/2023
Date Signed: 08/10/2023 09:08:16 AM


Document Has Been Signed on 08/10/2023 09:08 AM - 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:PAPA JOE'S HANDSFACILITY NUMBER:
198320164
ADMINISTRATOR:SWAFFORD, RASHIMERFACILITY TYPE:
740
ADDRESS:216 E. 137TH. ST.TELEPHONE:
(310) 562-7694
CITY:LOS ANGELESSTATE: CAZIP CODE:
90061
CAPACITY:4CENSUS: DATE:
06/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:41 AM
MET WITH:Rashimer SwaffordTIME COMPLETED:
11:00 AM
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On 06/22/23 at, Licensing Program Analyst (LPA) Felisa Shirley conducted an annual required visit, with a primary focus on infection control measures. LPA was met by Rashimer Swafford and the purpose of today’s visit was explained. The facility is licensed to serve four (4) ambulatory residents ages 60 and over; with a hospice waiver for three (3) residents. Facility did not have any residents at the time of the visit.

LPA and Rashimer Swafford toured the facility. The home consists of four (4) bedrooms, three (3) bathrooms, living Room, kitchen, dining area, garage, gas fireplace, and back yard. The water temperature measured at 109.8 f degrees. All rooms were checked, and mattresses and bedsprings are in good repair, adequate lighting, nightstand, chair, and closet space observed. Sufficient toiletries, linens towels and bedding for clients. First Aid kit was fully stocked with manual. Fire extinguisher was charged, smoke/carbon monoxide detectors were operable.

Perishable and non-perishables food supply was adequate at time of visit. Outside grounds were toured. Backyard was free of debris, exit-ways and pathways were clear of hazards. All disinfectants, toxins, knives, and cleaning solutions were locked and inaccessible to clients. No bodies of water were observed.

During today’s visit there were no deficiencies cited.

Exit interview was conducted and a copy of the facility evaluation report was given to Rashimer Swafford.

SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa ShirleyTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2023
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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