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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320354
Report Date: 01/24/2025
Date Signed: 01/24/2025 01:16:12 PM

Document Has Been Signed on 01/24/2025 01:16 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:LADERA SUNRISEFACILITY NUMBER:
198320354
ADMINISTRATOR/
DIRECTOR:
MOORE, TRACYFACILITY TYPE:
740
ADDRESS:5551 S CORNING AVETELEPHONE:
(310) 733-9604
CITY:LOS ANGELESSTATE: CAZIP CODE:
90056
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
01/24/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:36 AM
MET WITH:Tracy Moore,Administrator TIME VISIT/
INSPECTION COMPLETED:
01:20 PM
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On 01/24/2025 Licensing Program Analyst (LPA) Yolanda Rosser arrived at facility for unannounced Annual visit. LPA explained the purpose of visit was to conduct Annual visit. House Manager, Wendy explained Licensee, Tracy Moore was away from facility, would contact her. House Manager Wendy allowed entrance to LPA into the facility.

LPA later met with Tracy Moore, Administrator and explained the purpose of the visit. The facility is licensed to serve 6 non-ambulatory residents with dementia of which one(1) may be bedridden in room #3. The facility has an approved hospice waiver for 6 residents. The facility does not handle any of the residents money.

This home is a single story home consisting of: (5) resident bedrooms, (4) full bathrooms , living room, kitchen with dining area/activity area, office and staff area (located in the attached garage). LPA toured the residents bedrooms. All rooms had the required furniture. There was enough bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non skid mat was in place, water temperature measured between 111F and 118F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions.

Kitchen was checked and observed to be within Title 22 regulations. Perishable and non perishable food supply was checked. All cleaning solutions, hazardous items and medications were securely locked and inaccessible to residents. Smoke detectors were working properly and fire extinguishers were fully charged, carbon monoxide detector was operational. First aid kit was available. Outside grounds were toured and an outdoor shaded patio area with a fenced pool in backyard was observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. Fire drills are conducted monthly. An exit interview was conducted and no deficiencies were cited today. A copy of this report was left with the Administrator at time of visit.
Eva M AlvarezTELEPHONE: (323) 629-7047
Yolanda RosserTELEPHONE: (424) 544-1082
DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2025
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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