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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320396
Report Date: 10/03/2024
Date Signed: 10/03/2024 04:16:20 PM

Document Has Been Signed on 10/03/2024 04:16 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:SAFE HAVEN ADULT HOMEFACILITY NUMBER:
198320396
ADMINISTRATOR/
DIRECTOR:		STOWE, YOLANDAFACILITY TYPE:
735
ADDRESS:4222 E. LINSLEYTELEPHONE:
(310) 864-5421
CITY:COMPTONSTATE: CAZIP CODE:
90221
CAPACITY: 5CENSUS: 0DATE:
10/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Yolanda StoweTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 10/03/24, Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with the Administrator, Yolanda Stowe and the purpose of the visit t was explained. The facility is licensed to operate for (5) ambulatory developmentally disabled or Mentally Ill adults ages 18 through 59. Currently, the home has (0) clients.

The facility is a one family home located in a residential neighborhood. The property consists of the following: 3 client bedrooms, 1 common bathrooms, living room, kitchen, dining area, family room, detached garage consists of game room and facility office.. The washer and dryer is located in the family room. LPA observed outdoor shaded gazebo area.

At 3:50 pm LPA and Administrator Yolanda Stowe toured the inside and outside of the facility. All client rooms were checked. Mattresses and box springs were in good condition, adequate lighting was observed, plenty of dresser and closet space was observed. Walls and floors were clean and 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 regulation. Toilets and water faucets worked properly. Shower was free of mold/mildew, there is adequate lighting, and sufficient toiletries accessible to clients. The water temperature properly measured between 115 F).

No deficiencies were observed.

Exit interview conducted with Yolanda Stowe, Administrator and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Sparkle Day
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2024
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: SAFE HAVEN ADULT HOME
FACILITY NUMBER: 198320396
VISIT DATE: 10/03/2024
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Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Carbon monoxide detector was observed and operational. Smoke detectors were working properly, fire extinguishers were fully charged, toxins and knifes were locked and inaccessible to clients. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. Outside grounds were toured and no bodies of water were observed. Exits/ Walkways around the home were free of debris and hazards

During todays visit LPA did not observe any deficiencies.

Exit interview conducted with Aderian Afere,

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Sparkle Day
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC809 (FAS) - (06/04)
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