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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320201
Report Date: 07/16/2021
Date Signed: 07/16/2021 12:09:11 PM

Document Has Been Signed on 07/16/2021 12:09 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
MONTEREY PARK, CA 91754
FACILITY NAME:LAMAR'S HAVEN LLCFACILITY NUMBER:
198320201
ADMINISTRATOR:LAMAR, KANEESHAFACILITY TYPE:
740
ADDRESS:1618 E. TURMONT STREETTELEPHONE:
(562) 229-8047
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 4CENSUS: 0DATE:
07/16/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Kaneesha LamarTIME COMPLETED:
12:30 PM
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LPA met with Kanesha Lamar and was granted access into the home. Licensing Program Analysts (LPA), Martessa Brown conducted an announced visit to the facility for purpose of a pre-licensing evaluation.

An application was submitted to CCLD on 3/19/21, for the Initial license for a Residential Care Facility for the Elderly to serve elderly residents ages 60 and over. The requested capacity is for 4 ambulatory residents.
During today's visit LPA observed the facility has Personal Protective Equipment (PPE) supplies and mask posting. LPA observed the facility infection control practices such as screening protocols for visitors, staff and residents, sanitizing station.
Facility is a 5 bedroom, 2 bathrooms, two story house with a 2-car attached garage. The resident’s bedrooms are spacious and will easily accommodate the client's furnishings. There is a back yard with a covered patio for shade. Outdoor passageways, walkways, driveways, steps and patios are free from obstructions. LPA did not observe hazards, such as ladders, gardening tools and/or motorized equipment in the front, back and/or side areas of the facility. Bedrooms Residents: All Bedrooms are for 4 ambulatory residents. Bedroom # 1, # 3 and #4 each have beds, chairs, night stands, lamps in addition to overhead lighting. There is dressers for each resident with four drawers in Bedrooms #1, #2 and #3 which comply with the requirement of 8 cubic feet of space. Bedroom #2 was observed and will be used as a staff room. Bedroom #5 was observed and will be used as a TV room. Bathroom: Bathroom #1 and #2 has a working toilet, wash basins, nonskid mats and shower. LPA observed adequate lighting in hallway. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored in hall closet.

Emergency Phone Numbers, Exit Plan & Menu: The telephone system has a working land line. Emergency Disaster Plan and "See something, say something Let Us Know" posted & readily available for review on the wall between the living room and kitchen. Menu available for review located in the kitchen cabinet opposite the refrigerator. Fire Extinguisher mounted on the kitchen wall opposite postings.

LIC809-C is on the next page

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Martessa Brown
LICENSING EVALUATOR SIGNATURE: DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: LAMAR'S HAVEN LLC
FACILITY NUMBER: 198320201
VISIT DATE: 07/16/2021
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Food Service: Dishes, cups and flat ware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are stored in a locked cabinet located in the kitchen area. Food supply is adequate; stored in kitchen refrigerator and cabinets and consists of the following: A variety of Fresh and Canned fruit, vegetable and meat food items. Smoke Detectors: 6 hard wired smoke detectors are battery and electric operated & working. 2 Carbon monoxide detector located and mounted in the living room and is operational. Appliances: Stove burners, oven, microwave, washer, and dryer are working. There is 1 refrigerator in the kitchen and one in the garage. Refrigerator in the kitchen has a measured temperature of at least 47 degrees Fahrenheit for appropriate food storage. Freezer is at 0 zero degrees Fahrenheit. The residents are equipped with central air and heat and each resident’s bedroom. Toxins: Locked/stored in the bottom cabinet located in the kitchen. Water Temperature: Bathroom #1 Tested at 119 F and #2 119.5 F degrees. Medications, First-Aid Kit & Book: Medication administration records and first aid kit has been inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and first aid manual observed, which are stored in hallway cabinet adjacent from the kitchen. Medicine cabinet and residents medication books are located in the kitchen above the refrigerator and locked in the cabinet available for staff use but inaccessible to residents. Residents & Staff Files: accessible to designated staff. Records of staff and residents shall be stored in a locked in office and the section has been inspected along with the available records present.

Reading Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the residents use. Activity board will be posted on the wall between the kitchen and the living room. Pool/Jacuzzi & Pets: LPA did not observe any pet or bodies of water at the facility. Fire clearance: Fire Clearance was approved on 5/12/21 for 4 ambulatory residents with no special instructions. LPA did not observe delayed egress, chain locks or dead bolts on exits. LPA did not observe pad locks or other mechanisms which may be obstructions for safe and quick egress during an emergency on side gates and front exits.

Component III: Conducted at the Pre-Licensing visit, on 7/16/21 at Lamar’s Haven LLC Residential Facility, information provided about how to operate the facility within substantial compliance.



An exit interview was conducted, and a copy of this report has been furnished to the applicant. LPA Brown will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Martessa Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
LIC809 (FAS) - (06/04)
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