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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600477
Report Date: 11/22/2024
Date Signed: 11/22/2024 12:28:48 PM

Document Has Been Signed on 11/22/2024 12:28 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:CAREMORE AID & BOARD FACILITYFACILITY NUMBER:
198600477
ADMINISTRATOR/
DIRECTOR:
RONALD F ZABLOCKIFACILITY TYPE:
735
ADDRESS:14807 LEMOLI AVENUETELEPHONE:
(424) 269-1632
CITY:GARDENASTATE: CAZIP CODE:
90249
CAPACITY: 8CENSUS: 8DATE:
11/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:01 AM
MET WITH:LORNA B. CASTROTIME VISIT/
INSPECTION COMPLETED:
12:49 PM
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On 11/22/24, Licensing Program Analysts (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with administrator Lorna Castro. LPA explained the purpose of today’s visit. The facility is licensed to operate for ambulatory (8) mentally disabled adults ages 18-59 years.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: (5) client's rooms, (2) bathrooms, a living area, a dining area, a kitchen, an outside seating area, a staff bedroom, and a garage used for storage.

LPA toured the physical plant with Castro. There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the resident's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 105.7 degrees F. A comfortable temperature of 70 F. degrees was maintained in the facility.

LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Fire extinguishers were fully charged. A review of the Medication Records Administration (MAR) was observed to be maintained in place.

LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on 11/15/24. The facility had operational fire alarm and carbon monoxide in bedrooms and common areas. The fire alarm system is connected to the local fire department. The facility has current Liability Insurance. The facility does not handle client's personal finances.
(Evaluation Report continues LIC 809-C)
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024
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: CAREMORE AID & BOARD FACILITY
FACILITY NUMBER: 198600477
VISIT DATE: 11/22/2024
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During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. All mandated inspection control posters were posted. LPA observed the facility with Emergency Food Supply.

An audit of clients #1-#8 (C1-C8) service files and staff #1-#6 (S1-S6) personnel files revealed to be complete. The facility has the current administrator's certification on file for Ronald Zablocki # #6025128735 Exp. 03/01/25.

No deficiencies during this inspection visit.

Technical Assistance Advisory (LIC 9102) was issued.

An exit interview was conducted with Lorna Castro, and a copy of the report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2024
LIC809 (FAS) - (06/04)
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