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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320335
Report Date: 03/20/2025
Date Signed: 04/08/2025 09:49:37 AM

Document Has Been Signed on 04/08/2025 09:49 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:ATARAXIS HOMES #2FACILITY NUMBER:
198320335
ADMINISTRATOR/
DIRECTOR:
BUCKMAN, JAMESFACILITY TYPE:
740
ADDRESS:6536 SPRINGPARK AVETELEPHONE:
(424) 702-5686
CITY:LOS ANGELESSTATE: CAZIP CODE:
90056
CAPACITY: 6CENSUS: DATE:
03/20/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Manager, Ema LewisTIME VISIT/
INSPECTION COMPLETED:
04:55 PM
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On 03/20/25, Licensing Program Analyst (LPA) Yolanda Rosser conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with DSP, Ema Lewis as the purpose of the visit was explained. LPA, Rosser spoke with Administrator Brianne Bunch via phone who provided permission to Ema Lewis to conduct tour and sign on her behalf. Currently census is 6.

The facility is licensed to serve Dementia adults ages 60 and over, facility is approved for six (6) non ambulatory of which 1 may be bedridden. Facility has an approved hospice waiver for six (6). Liability insurance is active, Ema Lewis, House Manager was provided with facility fee info and PIN #188099.

The facility is a single-story structure located in a residential neighborhood and consists of the following: dining room, kitchen, pantry, laundry area, a staff work area, living room, family room, five (5) resident bedrooms, four (4) shared restrooms, an attached three (3) car garage used for storage, and a fenced swimming pool (non usage). Bedrooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathroom toilets and water faucets worked properly, shower was free of mold/mildew, and there are sufficient toiletries accessible to residents. The water temperature properly measured between 105-120 F.. A supply of perishable and non-perishable food was observed, toxins and knifes were stored and inaccessible to residents, no weapons on the premises, exits and walkways are free of debris/hazards.

LPA conducted a records review of 3 staff records, 3 resident records, and 3 medication administration records, no discrepancies observed. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The last fire was conducted on 02/2025, fire extinguishers observed and fully charged, carbon monoxide and smoke detectors are interconnected and operational.

Exit interview conducted and a copy of this report was provided to Manager, Ema Lewis.
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Yolanda Rosser
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2025
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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