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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601046
Report Date: 07/11/2023
Date Signed: 07/11/2023 03:50:04 PM

Document Has Been Signed on 07/11/2023 03:50 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:VENDOME HOME CAREFACILITY NUMBER:
198601046
ADMINISTRATOR:ROSE M. T. FONTANILLAFACILITY TYPE:
735
ADDRESS:140 SOUTH VENDOME STREETTELEPHONE:
(213) 427-9976
CITY:LOS ANGELESSTATE: CAZIP CODE:
90057
CAPACITY: 6CENSUS: 5DATE:
07/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:41 AM
MET WITH:Benedict GomezTIME COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA) LaQueena Lacy arrived to the facility at 10:34am to conduct a One (1) year Required Annual visit. LPA meet with staff Benedict Gomez and explained the purpose of this visit. The facility has one main entrance being used, the PPE screening station is located at the entrance of the facility with sufficient PPE readily accessible, handsanitizer, gloves, mask, and sign in sheet at the time of visit. The facility is a single story seven (07) bedrooms in which is designated as live in staff, two (02) bath with a detached garage. It is licensed for a capacity of six (06) ambulatory clients.
Kitchen: At 10:52am the kitchen was observed to be clean and an adequate supply of perishables and
non-perishable food located in the refrigerator, freezer, and pantry. Sharps were observed to be stored in the kitchen cabinet which was observed to be locked and inaccessible to clients. At 11:37am the fire extinguisher observed to be stored on the wall in the kitchen with a service tag dated 10/28/2022. (02) first aid kit was observed to be stored in a cabinet in the kitchen. The emergency food (02) four (04) person kit is located in the pantry
Bedrooms: At 11:06am LPA observed (07) bedrooms to be appropriately furnished with sufficient lighting. All bedrooms observed to be neat and clear from obstruction. LPA observed appropriate bed linen and comforters on all beds. All bedrooms observed for single occupancy. Second refrigerator located in the designated staff room.
Bathrooms: At 11:24am LPA observed (02) bathrooms to be clean and in proper operation. LPA observed appropriate grab bars in and around the toilet and shower in bathroom number one (01). The water temperature measured in range of 117.1 between 118.7 degrees Fahrenheit. Hand towels are not shared. Trash can contain lids. Extra linens and sheets were observed to be stored in a cupboard adjacent to the bathtub in bathroom number (01).

Continued on LIC809C
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: LaQueena Lacy
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: VENDOME HOME CARE
FACILITY NUMBER: 198601046
VISIT DATE: 07/11/2023
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Medications: LPA observed the medication cupboard located in the kitchen at 11:39am to be locked and inaccessible to clients.
Laundry Room: At 11:44am LPA observed the laundry room to be locked, clean and clear from obstruction and inaccessible to clients, storing laundry supplies, cleaning solutions and toxins. Extra personal care items were observed to be locked in a cupboard.
Backyard: At 11:51am LPA observed the outside and surrounding area of the facility to be clean and clear from obstruction. The facility has an owning with a table and chairs for lounging in the front yard. LPA observed a detached garage that was not identified on the facility sketch provided to licensing. LPA spoke with the administrator Leticia Gomez at 11:57am and discussed the submission of a new facility sketch to identify the garage located behind the facility. Per Gomez the building has always been there and is not something that was built after licensing. The garage is being used by her niece who is not associated with the facility or has any access to the facility. The garage has its own entrance and exits and gate access from the alley behind the facility, but can also been accessed through the facility front gate. It is not an Accessory Dwelling Unit (ADU) and the niece does not pay rent.
Living, dining room and common areas: At 12:15pm LPA observed these areas to be appropriately furnished with tables and chairs and adequate lighting. The facility maintains a comfortable temperature at 76-degree Fahrenheit. Observed to be neat and clean. LPA observed the activities stored in a cupboard in the dining room.
At 12:27pm the fire alarm system was tested and observed to be working, it is hard wired throughout facility. At 12:35pm the carbon monoxide detector located on the wall in the hallway was tested and to be functioning and operational.

Due to time constraints, LPA was unable to complete the annual and required tool, LPA’s will return at a later date to complete the inspection.

No Deficiency cited, exit interview conducted, and copy of this report issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: LaQueena Lacy
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023
LIC809 (FAS) - (06/04)
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