198320164-7-15-2026-11-AS-TWAN-DVZVYR-20260715165134

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320164
Report Date: 07/15/2026
Date Signed: 07/15/2026 04:52:05 PM

Document Has Been Signed on 07/15/2026 04:52 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:	PAPA JOE'S HANDS		FACILITY NUMBER:	198320164
ADMINISTRATOR/ DIRECTOR:	SWAFFORD, RASHIMER		FACILITY TYPE:	740
ADDRESS:	216 E. 137TH. ST.		TELEPHONE:	(310) 562-7694
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90061
CAPACITY: 4		CENSUS: 4	DATE:	07/15/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	LEAD STAFF - KENDRA HOWARD		TIME VISIT/ INSPECTION COMPLETED:	04:50 PM

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On 07/14/2026, at approximately at 09:30AM, Licensing Program Analyst (LPA) Troy Watson conducted an unannounced annual visit using the CARE Inspection Tool. The department met with lead Direct Support Staff Kendra Howard, and the purpose of the visit was explained. The facility is licensed to serve four (4) elderly adults aged 60 and above, with an approved hospice waiver for three (3) residents.

Physical Plant / Structure

The facility is a single-story home located in a residential neighborhood. It consists of six (4) resident bedrooms, three (3) bathrooms, a living room, dining room, kitchen, attached garage, and an outdoor patio area and back yard. All exterior walkways were clean, clear, and free of debris, obstructions, or hazards. The department observed an outdoor table with a shaded roof area and chairs for residents’ use. No bodies of water were observed on the premises.

CONTINUED ON LIC9099-C

Stephanie Cifuentes
Troy Watson
	DATE: 07/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: PAPA JOE'S HANDS	FACILITY NUMBER: 198320164
	VISIT DATE: 07/15/2026

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Bedrooms

All residents’ bedrooms were inspected and found clean and in good repair. Each room had the required furniture: bed, dresser, nightstand, chair, and adequate storage for personal belongings. Beds had required linens, including mattress covers, fitted sheets, blankets, comforters, and pillows. An additional supply of linens in good repair was stored in a hallway closet. Each bedroom had sufficient lighting.

Bathrooms

All bathrooms met Title 22 requirements and were operable. Showers were clean and free of mold or mildew. Resident hygiene boxes and extra hygiene products were stored in the hallway closet. The supply of towels, hand towels, and washcloths was adequate. Safety handrails were secured. A sufficient supply of incontinent products was observed. Cleaning supplies were locked and inaccessible under the kitchen cabinets.
Water temperatures measured in the bathrooms between 113.4 ° F.

Kitchen

The kitchen was clean and sanitary. All appliances were operable and in good repair. Dishware, cookware, and utensils were adequately supplied and in good condition. The facility had at least a 3-day supply of perishable food and a 7-day supply of non-perishable food, properly stored, labeled, and dated. Cleaning supplies and toxins were locked and inaccessible under the kitchen sink. Water temperature measured 118.2 °F.

CONTINUED ON LIC9099-C

NAME OF LICENSING PROGRAM MANAGER: Stephanie Cifuentes
NAME OF LICENSING PROGRAM ANALYST: Troy Watson
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

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: PAPA JOE'S HANDS	FACILITY NUMBER: 198320164
	VISIT DATE: 07/15/2026

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Common Areas

The living room contained four (2) couches and the tv room included 4 recliners for resident use. Games and activities were available. The dining room had a large table with seating for all residents. The facility was appropriately furnished. A screened fireplace was observed and was inaccessible to residents. Interior walkways and hallways were clean, clear, and free of hazards. The indoor temperature was maintained at 78.2°F.

Files

The department reviewed four (4) resident files and found required documents present. The department reviewed the Administrator file and three (3) staff files and verified required documents, training, and certifications.

Medications

Medications were locked in a kitchen cabinet and inaccessible to residents. All medications were observed in their original packaging. The department reviewed medications and Medication Administration Records (MARs) for four (4) residents and found all records consistent and properly documented.

CONTINUED ON LIC9099-C

NAME OF LICENSING PROGRAM MANAGER: Stephanie Cifuentes
NAME OF LICENSING PROGRAM ANALYST: Troy Watson
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

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: PAPA JOE'S HANDS	FACILITY NUMBER: 198320164
	VISIT DATE: 07/15/2026

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Safety

Nine (9) smoke detectors and carbon monoxide detectors were operable. One (1) fully charged fire extinguishers was last serviced on 06/24/2025. The First Aid kit contained all required items and a current manual. The facility has an operational landline telephone. All exits were marked with EXIT signs. All doors had alarms that sounded when opened. Required postings were observed in the hallway near the entrance.

Infection Control

The department observed infection control procedures, including a sanitizing station at the entrance with a visitor log, hand sanitizer, thermometer, and masks. The facility had a 30-day supply of PPE. All required infection control signage was posted.

During today’s visit, no deficiencies were observed or cited.
An exit interview was conducted with lead Direct Support Staff, and a copy of this report was provided.

CONTINUED ON LIC9099-C

NAME OF LICENSING PROGRAM MANAGER: Stephanie Cifuentes
NAME OF LICENSING PROGRAM ANALYST: Troy Watson
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

LIC809 (FAS) - (06/04)

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