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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600284
Report Date: 10/20/2023
Date Signed: 01/25/2024 04:08:24 PM

Document Has Been Signed on 01/25/2024 04:08 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:CHERONA'S PLACE 2FACILITY NUMBER:
198600284
ADMINISTRATOR:BRENDA HARRISONFACILITY TYPE:
735
ADDRESS:14701 DUBLIN AVENUETELEPHONE:
(310) 523-1728
CITY:GARDENASTATE: CAZIP CODE:
90249
CAPACITY: 3CENSUS: 3DATE:
10/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Sharon BabbTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced Annual inspection visit and infection control inspection to the above facility. LPA was met with Sharon Babbs, Administrator and the purpose of today’s visit was explained.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: 3 bedrooms, 2 bathrooms, family room/office, living room, kitchen, dining room, shaded back porch, indoor and outdoor activity area, covered front porch with ramp, shaded side patio with ramp, and laundry room in the attached 2 car garage.

LPA Shirley and Sharon toured the entire facility inside and out. All bedrooms are occupied by clients and contain the mandated furniture. The (2) bathrooms are clean and operational. Water temperature measured at 100.8. Smoke detectors and carbon monoxide detector comply and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to clients. A comfortable temperature is maintained in the facility. Ample supply of perishable and nonperishable food, linens and personal hygiene supplies are adequate, hazardous toxins and/or items are inaccessible to clients, (2) fire extinguishers are fully charged. First Aid kit complete and with manual. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time.

An exit interview conducted with Ana Diaz, Caregiver and copy of report provided.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2023
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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