198320445-2-5-2025-11-AS-FSHY-DDFS6F-20250131123552

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320445
Report Date: 01/31/2025
Date Signed: 02/05/2025 05:49:05 PM

Document Has Been Signed on 02/05/2025 05:49 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:	GENEROSITY RESIDENTIAL, LLC		FACILITY NUMBER:	198320445
ADMINISTRATOR/ DIRECTOR:	COLE, KEITH		FACILITY TYPE:	735
ADDRESS:	1606 W. 81ST STREET		TELEPHONE:	(310) 702-9572
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90047
CAPACITY: 4		CENSUS:	DATE:	01/31/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:58 AM
MET WITH:	Keith Cole, Administrator		TIME VISIT/ INSPECTION COMPLETED:	12:30 PM

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On 1/31/25, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced required annual visit using the full CAREs Inspection Tool. LPA met with Administrator, Keith Cole and explained the purpose of today’s visit. The facility is licensed to serve elderly developmentally disabled residents ages 18 thru 59 years old.

LPA reviewed all resident files and found that they did contain all required documents. LPA reviewed three (3) staff files and found they did contain all required documents, training, and certification. During file review, LPA observed the surety bond.

LPA Felisa and Keith toured both inside and outside of the facility. The facility is a one-story structure located in a residential neighborhood. The facility consists of (4) client bedrooms, (3) bathrooms, living room, kitchen, and dining area. Facility maintains all required posting throughout the facility.

All bedrooms were toured. Bedrooms 1-4 are occupied by residents and contain the mandated furniture. LPA observed all rooms to have the required furniture including a bed, dresser(s), nightstand(s), and chair(s). All beds had the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillow. LPA observed ample lighting in all the bedrooms.

LPA Shirley and Keith toured the kitchen and found it to be clean and sanitary. All appliances were in good working order. Knives were locked and stored. The medications were locked and stored in the file cabinet located in the living room. LPA observed a 3-day supply of perishable and a 7-day supply of nonperishable foods.

con'd on 809-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025

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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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: GENEROSITY RESIDENTIAL, LLC	FACILITY NUMBER: 198320445
	VISIT DATE: 01/31/2025

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The (3) bathrooms are clean and operational. First aid kit is fully stocked with manual. No firearms are stored at facility and no bodies of water present. This facility is in good repair. The water delivered at 112.8 degrees.

LPA Shirley and Keith walked through all common areas. In the living room, kitchen, dining room there is ample seating and space for all residents. All rooms and walkways were clean, and clear of obstructions and hazards. All areas have ample lighting. All rooms, hallway, and living room have working smoke detectors. There is a charged fire extinguisher in the kitchen. The backyard is clean and clear of obstructions and hazards, and there are no bodies of water present.

An exit interview was conducted, and a copy of this report was provided to the Administrator, Keith Cole.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025

LIC809 (FAS) - (06/04)

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