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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320403
Report Date: 11/02/2024
Date Signed: 11/02/2024 04:03:15 PM

Document Has Been Signed on 11/02/2024 04:03 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:ARW HOME CARE INCFACILITY NUMBER:
198320403
ADMINISTRATOR/
DIRECTOR:
JOSE, REMEDIOS CECILIAFACILITY TYPE:
740
ADDRESS:505 E LINCOLN STTELEPHONE:
(310) 684-1328
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY: 6CENSUS: 0DATE:
11/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Norma GranetaTIME VISIT/
INSPECTION COMPLETED:
01:46 PM
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On 11/02/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with designated administrator Norma Graneta and explained the purpose of today’s visit. The facility is licensed to operate for (4) non-ambulatory of which one (1) may be ambulatory and (1) bedridden elderly residents ages 60 and above. The facility is approved for (6) hospice residents. Currently, the facility has no residents in care.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident's rooms, two (2) common bathrooms, a living area, a dining area, a kitchen, an outside covered patio area, and (2) car garage.

LPA and administrator toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 105.9 degree F. A comfortable temperature of 73 degree was maintained in the facility.

LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Fire extinguisher were charged, smoke detectors and carbon monoxide were operable. A landline telephone was in working condition. A review of staff CPR/First Aid training is current.

Evaluation Report Continues LIC 809-C
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2024
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: ARW HOME CARE INC
FACILITY NUMBER: 198320403
VISIT DATE: 11/02/2024
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During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The Emergency Disaster Plan LIC610E, Personal Rights LIC 613, Facility Floor Plan, Food Menu and Activities Schedule all posted.

LPA observed First Aid Kit was maintained. The facility has current liability insurance on file effective 01/01/24 - 01/01/25 policy # 00151519-0. The facility is current on Community Care Licensing annual dues.

An audit of staff #1-#3 (S1-S3) personnel files revealed to be complete. The facility has the current administrator's certification on file for Remedios Jose #6066098 - Expiration 04/12/24.

No deficiencies during this inspection visit.

An exit interview was conducted with Norma Graneta, and a copy of the report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2024
LIC809 (FAS) - (06/04)
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