198600523-6-12-2023-11-AS-LVIS-CSQUTW-20230612155237

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198600523
Report Date: 06/12/2023
Date Signed: 06/12/2023 03:52:41 PM

Document Has Been Signed on 06/12/2023 03:52 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	COELLO'S RESIDENTIAL CARE		FACILITY NUMBER:	198600523
ADMINISTRATOR:	COELLO, BESSIE L.		FACILITY TYPE:	735
ADDRESS:	4325 WEST 168TH STREET		TELEPHONE:	(310) 292-8425
CITY:	LAWNDALE	STATE: CA	ZIP CODE:	90260
CAPACITY: 6		CENSUS: 4	DATE:	06/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Administrator Bessie L. Coello		TIME COMPLETED:	11:45 AM

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On 06/12/23, Licensing Program Analyst (LPA) Lizeth Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Administrator Bessie L. Coello and the purpose of today’s visit was explained. The facility is licensed to serve six (6) ambulatory, developmentally disabled adults ages 18-59. Residents are linked with the Westside regional enter.

The facility is a single-story home in a residential neighborhood that consists of 3 resident bedrooms, 2 bathrooms, living room, dining room, kitchen, staff working area, outdoor patio with a shaded area, and a detached garage that stores additional PPE.

LPA conducted a records review of two (2) staff records, two (2) resident records and two (2) Medication Administration Records. LPA did not observe any discrepancies at the time of visit. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The last fire drill was conducted on 05/25/23, (1) fire extinguishers fully charged, carbon monoxide detectors and smoke detectors interconnected are working properly. Landline observed throughout the facility.

All resident rooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathrooms were found to be within Title 22 regulation, toilets and water faucets worked properly, shower was free of mold/mildew, all grab bars were securely attached, and all showers had a non-skid mat and there is sufficient toiletries accessible to residents. The water temperature properly measured between 105-120 F..

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: COELLO'S RESIDENTIAL CARE	FACILITY NUMBER: 198600523
	VISIT DATE: 06/12/2023

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Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Toxins and knifes were observed to be locked and inaccessible to residents. Exits/ Walkways around the facility were free of debris and hazards.

During today’s visit no discrepancies were observed, exit interview conducted with

Administrator Bessie L. Coello, and a copy of this report was provided

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023

LIC809 (FAS) - (06/04)

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