198600131-10-1-2024-11-AS-FSHY-D8XUTY-20240909155242

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198600131
Report Date: 09/09/2024
Date Signed: 10/01/2024 04:22:26 PM

Document Has Been Signed on 10/01/2024 04:22 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:	CHERONA'S PLACE		FACILITY NUMBER:	198600131
ADMINISTRATOR/ DIRECTOR:	BRENDA HARRISON		FACILITY TYPE:	735
ADDRESS:	2907 WEST 138TH STREET		TELEPHONE:	(310) 930-2530
CITY:	GARDENA	STATE: CA	ZIP CODE:	90249
CAPACITY: 6		CENSUS: 4	DATE:	09/09/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:48 PM
MET WITH:	Sharron A. Babb, Administrator		TIME VISIT/ INSPECTION COMPLETED:	04:00 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

On 9/9/24, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced required annual visit using the full CAREs Inspection Tool. LPA met with Administrator, Sharon Babb and explained the purpose of today’s visit. The facility is licensed to serve elderly developmentally disabled residents ages 18-59 years old. This facility is cleared for six (6) ambulatory residents, and currently has 4 ambulatory residents.

LPA reviewed all resident files and found they contained the required documents. LPA reviewed four (4) staff files and found they contained the required documents, training, and certification. LPA reviewed the surety bond.

LPA Felisa and Sharon toured both inside and outside of the facility. The facility is a one-story structure located in a residential neighborhood. The facility consists of 3 bedrooms, of which all rooms are occupied by clients, (2) bathroom, one for residents and one for the staff, living room, den, kitchen, dining area, shaded patio area, garage used for storage. The washer and dryer are in good condition and are located on the back service porch. Facility maintains all required posting throughout the facility.

All bedrooms were toured. Bedrooms 1-3 are occupied by residents and contain the mandated furniture. LPA observed all rooms to have the required furniture including a bed, dresser(s), nightstand, 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 and the hallway.

LPA Shirley and Sharon toured the kitchen and found it to be clean and sanitary. All appliances were in good working order. Knives were locked and stored in the medicine cabinet. The medications were locked and stored in a cabinet located in the kitchen. LPA observed a 3-day supply of perishable and a 7-day supply of nonperishable foods. The water temperature measured 117.4 degrees Fahrenheit.

Con'd on 809-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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: CHERONA'S PLACE	FACILITY NUMBER: 198600131
	VISIT DATE: 09/09/2024

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
26
27
28
29
30
31
32

The (2) bathrooms and 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.

LPA Shirley and Sharon 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 by the front door and one by the back door. The backyard is clean and clear of obstructions and hazards, shaded patio area and there are no bodies of water present.

No deficiencies were issued.

An exit interview was conducted, and a copy of this report was provided to Administrator, Sharon Babb.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2