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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600661
Report Date: 12/29/2023
Date Signed: 12/29/2023 11:20:56 AM

Document Has Been Signed on 12/29/2023 11:20 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:OUR HOUSE THEATRICAL LIVING & LEARNING CENTERFACILITY NUMBER:
198600661
ADMINISTRATOR:SHAHWAN, BARBARAFACILITY TYPE:
775
ADDRESS:1123 E DOMINGUEZ ST. SUITE CTELEPHONE:
(310) 763-4998
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 80CENSUS: 53DATE:
12/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Owner Filomina L. SandersTIME COMPLETED:
12:00 PM
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On 12/29/23 Licensing Program Analysts (LPA) Lizeth Villegas made an unannounced visit to the Our House Theatrical Living & Learning Center and met with Program owner Filomina L. Sanders as the purpose of today's visit was explained. The facility is licensed to serve eighty (80) adults of which seventy-eight (78) may be non-ambulatory. The staff to consumer ratio is one (1) staff to three (3) consumers.

As a part of today's inspection LPA reviewed five (5) consumer records, three (3) staff records and inspected the physical plant.The facility is a single-story structure located in a commercial building. The facility is one large building consisting of the following: Parking lot (drop off/pick up area), kitchen, 1 large activity room, 3 changing/isolation room, 1 waiting room/office, 3 consumer restrooms, 2 staff restroom, conference room and offices.

Facility walls and floors were in good condition, adequate lighting, plenty of storage space available for consumers, chemicals and sharps were properly locked. The restrooms were clean and within Title 22 regulations. Smoke alarms and carbon monoxide detectors observed and operational, last fire drill conducted on 10/27/23. Fire extinguishers were properly charged and observed throughout the facility, first aid kit was available and fully stocked.

LPA observed sufficient furniture and lighting throughout the facility, walkways throughout the day program and all exits were clear of hazards and debris. Consumers bring their own meals and program provides snacks only, no medication is currently administered at day program.

During today’s visit no discrepancies were observed. Exit interview conducted with Owner

Filomina L. Sanders, and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE: DATE: 12/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/29/2023
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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