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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601627
Report Date: 11/26/2024
Date Signed: 11/26/2024 01:12:20 PM

Document Has Been Signed on 11/26/2024 01:12 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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:SEAVIEW HOMEFACILITY NUMBER:
198601627
ADMINISTRATOR/
DIRECTOR:
MITZI NAKAMURAFACILITY TYPE:
740
ADDRESS:4021 PALOS VERDES DRIVE SOUTHTELEPHONE:
3104082528
CITY:RANCHO PALOS VERDESSTATE: CAZIP CODE:
90275
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:53 AM
MET WITH:Toshiko NakamuraTIME VISIT/
INSPECTION COMPLETED:
01:39 PM
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The Department of Social Services, Community Care Licensing Division (CCLD) staff conducted an unannounced Annual required visit. CDSS staff was met by family member Toshiko Nakamura (S1), and the purpose of today’s visit was explained. The facility is licensed to serve 6, non-ambulatory, elderly clients (60yrs+).
There are currently 0 residents in care and the facility is unoccupied. The facility is a one-story structure with 3 rooms and 3 bathrooms, dining room, living room, kitchen and patio and is located in a residential neighborhood.
CCLD staff and S1 toured the physical plant. There are no bodies of water or firearms/ammunition on the premises. All client rooms were checked and are in good condition, adequate lighting provided, storage for client personal belongings was observed. Walls and floors were in good repair. CCLD staff observed one fireplace without any screen, therefore CCLD staff have provided one (1) technical advisory note (LIC9102-AN). LPA observed the facility to be clean and appropriately furnished at the time of visit. Bathrooms were found to be clean and operational, within title 22 requirements. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were not accessible to clients. Smoke detectors/Carbon Monoxide were hard wired and tested and both are in working condition. CCLD observed one (1) fire extinguisher, fully charged with the needle in green. However, the device does not display any yearly maintenance log. Since the facility is unoccupied, CCLD staff have provided a technical advisory note, see LIC9102-AN.

During today’s visit there were no deficiencies observed or cited. There has been two (2) technical advisory notes, see LIC9102-AN

CCLD staff held an exit interview with staff one, Toshiko Nakamura (S1) and a copy of this report and two (2) LIC9102-AN's were provided.
Ulysses CoronelTELEPHONE: (323) 981-1755
Mario LeonTELEPHONE: (323) 981-1755
DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/26/2024
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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