198320455-12-11-2024-11-AS-ARID-DBUTSU-20241211135943

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320455
Report Date: 12/11/2024
Date Signed: 12/11/2024 02:00:04 PM

Document Has Been Signed on 12/11/2024 02:00 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:	SAFENEST LIVING LLC		FACILITY NUMBER:	198320455
ADMINISTRATOR/ DIRECTOR:	ESTELLE, SIRRAH		FACILITY TYPE:	735
ADDRESS:	1715 1/2 W 64TH ST		TELEPHONE:	(310) 776-5858
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90047
CAPACITY: 6		CENSUS: 0	DATE:	12/11/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:52 AM
MET WITH:	ESTELLE SIRRAH		TIME VISIT/ INSPECTION COMPLETED:	02:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	12/11/2024, Licensing Program Analyst (LPA) Antonine Richard conducted announced visit to this home. LPA was greeted by applicant Sirrah Estelle and Marcco Ware explained the purpose of today’s pre-licensing inspection visit. An application was submitted to CCLD on 02/02/2024/ in the initial license application for an Adult Residential Facility ages 18 and 59. The applicant requested a capacity of six (6) individuals, of which (0) non-ambulatory. Structure: The home consists of three (3) bedrooms, two (2) bathrooms, one (1) office. The home situated in a residential neighborhood. The home includes a living, dining, kitchen, and laundry area. The living room did not include a fireplace. The living area included a sofa with a chase seating. The kitchen has a refrigerator and stove. The rear exterior is fenced throughout. The passageways, walkways, and steps are free from obstructions. Bedrooms Residents: The facility had Three (3) bedrooms for clients. All rooms include a twin-size bed, two (2) chairs, two (2) nightstand, and two (2) table lamps. All bedrooms are equipped with a ceiling light. All rooms had a dresser, which complies with the requirement of 8 cubic feet of space. All rooms had closets for ample storage. Evaluation Report Continues

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024

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: SAFENEST LIVING LLC	FACILITY NUMBER: 198320455
	VISIT DATE: 12/11/2024

NARRATIVE

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Bedrooms Staff:
No bedroom is designated for live-in staff.

Bathrooms:
The home has two (2) bathrooms. Bathrooms are accessible in all rooms. The bathroom has a working toilet, washbasin, and shower and non-skid mats.

Linens & Hygiene Supplies:
Beds have the required linen supplies which include, pillowcases, mattress pads, fitted sheets, blankets, and bedspreads. An adequate supply of linen is stored in the living cabinets.

Emergency Phone Numbers, Exit Plan & Menu:
Emergency phone numbers. The exit plan and menu are posted and readily available for review throughout the home. There is two (2) fire extinguisher located in the kitchen one (1) in the living room. A telephone line is available in the living room, and in the office. Emergency supplies and Personal Protective Equipment supplies are stored in the kitchen sink. The applicant has an approved Infection Control Plan on file.

Food Service:
Dishes, cups, and flatware are stored in the kitchen cabinets, inspected, and in good repair. Knives, cutlery, and other sharp kitchen utensils are stored in a locked kitchen drawer. Food supply is adequately stored in kitchen cabinets and consists of the can goods. The kitchen counters also had small appliances.

Smoke Detectors:
Smoke and carbon monoxide detectors throughout the interior space. Hardwired smoke detectors in all three (3) bedrooms and hallways. Carbon monoxide is in the living room area.

Toxins:
All toxins are locked and stored under the kitchen sink cabinet.

Evaluation Report Continues

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: SAFENEST LIVING LLC	FACILITY NUMBER: 198320455
	VISIT DATE: 12/11/2024

NARRATIVE

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Evaluation Report Continues

Appliances:

Stove burners, oven, are working. The kitchen counters also had small appliances which includes, coffee maker, Microwave, and a Blender. There is one (1) refrigerator in the home. The refrigerator measured a temperature of at least 40 degrees Fahrenheit for appropriate food storage. The home with electric fans and heaters. The living area has a cooling/heating split system.

Water Temperature:
The water temperature is 116.8 degrees F. throughout the kitchen and bathrooms.

Medications, First-Aid Kit & Book:
A first aid kit is stored in inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze, and current first aid manual locked and inaccessible to residents. The resident's medications will be stored in the office. The first aid kit will be stored under the sink in the kitchen area and inaccessible to residents.

Resident & Staff Files:
The applicant is not handling the cash resources for residents. Records of staff and residents will be stored in a locked cabinet in the office room area.

Reading Material, Games, Equipment & Materials:
The facility has, books, magazines, tablet, video game, Play Station, and other recreational materials for the client’s use all stored in the living room.

Pool/Jacuzzi & Pets:
There are no pets, jacuzzi, or pool in the fenced area.

Evaluation Report Continues

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024

LIC809 (FAS) - (06/04)

Page: 4 of 4

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: SAFENEST LIVING LLC	FACILITY NUMBER: 198320455
	VISIT DATE: 12/11/2024

NARRATIVE

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Evaluation Report Continues

Fire clearance:

A Fire Clearance inspection was conducted on 10/11/2024 approved for a capacity of six (6) ambulatories.

Component III:
LPA Richard conducted the Pre-Licensing inspection along with the information provided about how to operate the facility within substantial compliance with Component III PowerPoint.

An exit interview was conducted, and a copy of this report has been furnished to the applicant Sirrah Estelle. LPA Richard will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to their application.

END OF REPORT

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024

LIC809 (FAS) - (06/04)

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