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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600562
Report Date: 06/20/2024
Date Signed: 07/02/2024 11:41:06 AM

Document Has Been Signed on 07/02/2024 11:41 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:BIANCA RESIDENTIAL CAREFACILITY NUMBER:
198600562
ADMINISTRATOR/
DIRECTOR:		HARRISON, JANICEFACILITY TYPE:
735
ADDRESS:4600 WEST 166TH STREETTELEPHONE:
(310) 370-2924
CITY:LAWNDALESTATE: CAZIP CODE:
90260
CAPACITY: 4CENSUS: 3DATE:
06/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:04 PM
MET WITH:Sarita Wellington, Assistant AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 06/20/24, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with house manager Sarita Wellington as the purpose of today’s visit was explained. The facility is licensed to serve two (2) ambulatory and two (2) non-ambulatory developmentally disabled adults ages 18-59. Residents are linked to the Westside regional center.

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 reviewed the training logs for staff.



LPA Shirley and Sarita toured both inside and outside of the facility. The facility is a one-story structure located in a residential neighborhood. The facility consists of (4) client bedrooms, which includes (1) vacant client bedroom, (1) staff room, (1) full bathroom, (2) quarter bathrooms, laundry area, living room, kitchen, dining area, patio, and the garage. Facility maintains all required posting throughout the facility.

All bedrooms were toured. Bedrooms 1-3 are occupied by residents. LPA observed all rooms to have the required furniture including a bed, nightstand(s), 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 Sarita toured the kitchen and found it to be clean and sanitary. All appliances were in good working order. Knives were locked and stored. The medications were locked and stored in the dining room and inaccessible to the resident. LPA observed a 3-day supply of perishable and a 7-day supply of nonperishable foods. The water temperature measured at 105.9 degrees Fahrenheit.

The (3) bathrooms 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.

con'd on 809-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
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: BIANCA RESIDENTIAL CARE
FACILITY NUMBER: 198600562
VISIT DATE: 06/20/2024
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LPA Shirley and Sarita 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 in the kitchen. The backyard is clean and clear of obstructions and hazards. There is a shaded area on the front porch and there are no bodies of water present.

There were no deficiencies present for this inspection.


An exit interview was conducted, and a copy of this report was provided to Assistant Administrator, Sarita Wellington.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
LIC809 (FAS) - (06/04)
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