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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601610
Report Date: 10/26/2023
Date Signed: 10/26/2023 11:49:09 AM

Document Has Been Signed on 10/26/2023 11:49 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:FAMILY HANDS ADULT CARE FACILITYFACILITY NUMBER:
198601610
ADMINISTRATOR:TINA E. SCRUGGSFACILITY TYPE:
735
ADDRESS:10016 LA SALLE AVENUETELEPHONE:
(323) 533-2396
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY: 4CENSUS: 3DATE:
10/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:John Tate, AdministratorTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced required 1- year visit. LPA Shirley explained the purpose of today's visit and access was granted. There are currently three (3), South Central Los Angeles Regional Center (SCLARC) Adult Residential Care Facility (ARF) consumers in placement. The facility's annual fees are current.

The facility is a story single-family home located in a residential neighborhood. LPA Shirley and Licensee John toured the facility which consisted of the following: Living room, dining room, kitchen, 2 bedrooms, 2 bathrooms, laundry room, shaded area, and indoor/outdoor activity areas. The front and back yard landscape is in good condition at the time of the visit.

Documents are posted as mandated. The following Title 22 regulated areas were audited and found to be in compliance: Bedrooms contain the required furniture, Bathrooms are clean and operational, with non-skid surface mats. Personal accommodations were observed for safety, privacy, and comfort. The kitchen was observed for the ability to prepare and serve food. There was an ample supply of perishable and nonperishable food. Medications are locked in the dining area cabinets, and records are current. The first aid kit is fully stocked with manual, smoke, and carbon monoxide detectors were in compliance, hot water temperature measured at 105.7 degrees Fahrenheit within the normal limits (105-120F degrees), the fire extinguishers are fully charged, there are adequate lights and linen supply. There are no firearms on the premises, The resident's bedroom windows have no sliding window lock with thumbscrews, all exit doors were in compliance, and no bodies of water were present. Hazardous items are inaccessible to clients, the yard is free of debris and hazards.

There were no deficiencies cited. Exit interview conducted.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2023
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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