198600284-11-14-2024-11-AS-FSHY-DATRC5-20241108115347

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198600284
Report Date: 11/08/2024
Date Signed: 11/14/2024 08:27:18 AM

Document Has Been Signed on 11/14/2024 08:27 AM - 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 2		FACILITY NUMBER:	198600284
ADMINISTRATOR/ DIRECTOR:	BRENDA HARRISON		FACILITY TYPE:	735
ADDRESS:	14701 DUBLIN AVENUE		TELEPHONE:	(310) 523-1728
CITY:	GARDENA	STATE: CA	ZIP CODE:	90249
CAPACITY: 3		CENSUS: 3	DATE:	11/08/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Sharron Babbs, Administrator		TIME VISIT/ INSPECTION COMPLETED:	12:00 PM

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On 11/8/24, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced required annual visit using the full CAREs Inspection Tool. LPA met with Administrator, Sharron Babb and explained the purpose of today’s visit. The facility is licensed to serve elderly developmentally disabled residents ages 60 years and older, cleared for three (3) non-ambulatory residents. During the time of visit all three (3) residents were present.

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 both Liability Insurance and the surety bond.

LPA Felisa and Sharron 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) client bedrooms, (2) bathroom, living room, kitchen, dining area, patio, garage used for storage and laundry area. 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.

LPA Shirley and Sharron toured the kitchen and found it to be clean and sanitary. All appliances were in good working order. Knives were locked and stored in a drawer in the kitchen. The medications were locked and stored in a cabinet in the den. LPA observed a 3-day supply of perishable and a 7-day supply of nonperishable foods. The water temperature measured 107.6 degrees Fahrenheit.

Con'd on 809-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024

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: CHERONA'S PLACE 2	FACILITY NUMBER: 198600284
	VISIT DATE: 11/08/2024

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The (2) bathrooms have grab bars 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 Sharron 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 are fire extinguishers by the front entrance and in the den. The backyard is clean and clear of obstructions and hazards, shaded patio area and there are no bodies of water present.

There were no deficiencies observed.

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

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024

LIC809 (FAS) - (06/04)

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