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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320324
Report Date: 06/13/2024
Date Signed: 06/13/2024 10:53:34 AM

Document Has Been Signed on 06/13/2024 10:53 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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:SERENITY N MOTION LLCFACILITY NUMBER:
198320324
ADMINISTRATOR/
DIRECTOR:		PERKINS, DETRAFACILITY TYPE:
735
ADDRESS:919 N SPRING AVETELEPHONE:
(310) 988-9706
CITY:COMPTONSTATE: CAZIP CODE:
90221
CAPACITY: 6CENSUS: 0DATE:
06/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:26 AM
MET WITH:Detra PerkinsTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On 06/13/24, at 09:30am, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced visit to Serenity N Motion LLC. The purpose of today’s visit was to conduct the required annual inspection, using the new Care Tool. LPA was met by Detra Perkins, Administrator, and the purpose of today’s visit was explained. The facility is licensed to serve 6 developmentally disabled clients (age 18-59) ambulatory only. Currently, the home has (0) ambulatory clients. The facilities’ annual fees are current.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: 3 bedrooms, 2 bathrooms, dining room, kitchen, living room, outdoor shaded area, and an attached garage.

LPA conducted a records review of (0) client records, (0) staff records, (0) clients Personal & Incidental Records and reviewed the facility disaster plan. The facility has no clients or staff. The facility disaster plan was current and in compliance with Title 22 at the time of visit.

At 10:00am, LPA toured the physical plant. There are no bodies of water or firearm/ammunition on the premises. All resident rooms were checked. Beds and bedding were in good condition, adequate lighting provided, adequate storage for client personal belongings was observed. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations. Toilets and water faucets worked properly. The shower was free of mold/mildew, there is adequate lighting, and sufficient toiletries accessible to clients. The water temperature in the kitchen measured 115.3F. A comfortable temperature is maintained in the facility.

Report continued on LIC809-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2024
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: SERENITY N MOTION LLC
FACILITY NUMBER: 198320324
VISIT DATE: 06/13/2024
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LPA observed the facility to be clean and appropriately furnished at the time of visit. All window screens are clean and in good repair. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were inaccessible to clients. The kitchen was inspected and there is enough perishable and non-perishable food available, which is stored properly. First aid kit was checked and fully stocked. The fire extinguisher was charged and last inspected on 1/28/2022. Smoke/ Carbon Monoxide detectors were operable.

During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents. LPA observed that a sanitizing station along with sign in sheets and temperature testing was located at the entrance of the facility. LPA observed that the facility had the required postings, posted throughout the facility. LPA further observed the facility to have a 90-day supply of Personal Protective Equipment (PPE).

LPA advised the administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing (www.cdss.ca.gov) for Provider Informational Notices (PIN) and for any updates relating to COVID-19 guidance and other related issues.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time.

During today’s visit there were no deficiencies observed.

An exit interview was held, and a copy of this report was provided to Detra Perkins, Administrator.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC809 (FAS) - (06/04)
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