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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320329
Report Date: 01/29/2024
Date Signed: 01/29/2024 11:50:39 AM

Document Has Been Signed on 01/29/2024 11:50 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:DALTON CARE HOMES, INC.FACILITY NUMBER:
198320329
ADMINISTRATOR:QUAN, MARIAFACILITY TYPE:
735
ADDRESS:16015 S. DALTON AVENUETELEPHONE:
(310) 714-6537
CITY:GARDENASTATE: CAZIP CODE:
90247
CAPACITY: 6CENSUS: 3DATE:
01/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Mariel Ventura, AdministratorTIME COMPLETED:
11:55 AM
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On 1/29/24, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced annual required visit with a primary focus on Infection Control measures. LPA was met by Administrators, Marial Ventura and Joy Suarez and explained the purpose of today’s visit and was granted entry. The facility has a census of 3. One resident is hospitalized.

The facility is a one-story structure located in a residential neighborhood. The facility consists of (4) client bedrooms, (1) miscellaneous room (2) bathrooms, kitchen, dining area, living room, garage, back yard, and patio with shaded porch. Facility maintains all required posting throughout the facility.

LPA Shirley, Mariel and Joy walked through the kitchen and all appliances were in good working order. Knives were locked and stored in the drawer in the kitchen, medications were locked in the cabinet in the dining room and inaccessible to residents. LPA observed a 3-day supply of perishable and a 7-day supply of nonperishable foods. The water temperature measured 110.5 degrees Fahrenheit.

LPA observed the facility is clean, sanitary, and in good repair. Indoor and outdoor passageways, open porches, and other areas of potential hazard are free of obstructions. Facility temperature is between 68° degrees and 85° degrees. Open porches, and areas of potential hazard are well-lit and equipped with sturdy hand railings. Carbon monoxide/Smoke detectors operate properly.

There are ample amounts of first-aid supplies and first-aid manual. There is working washer and dryer located on the service porch. There is an operating telephone available to clients. Emergency lighting and supplies to include flashlights with batteries.

The backyard is clean and clear of obstructions and hazards and there are no bodies of water present.

Con'd on 809-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2024
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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: DALTON CARE HOMES, INC.
FACILITY NUMBER: 198320329
VISIT DATE: 01/29/2024
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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.

An exit interview was conducted, and a copy of this report was provided to Administrator, Mariel Ventura.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024
LIC809 (FAS) - (06/04)
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