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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601873
Report Date: 06/02/2023
Date Signed: 07/17/2023 09:13:08 AM

Document Has Been Signed on 07/17/2023 09:13 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:LADERA HOME 2FACILITY NUMBER:
198601873
ADMINISTRATOR:GABRIELA VAZQUEZFACILITY TYPE:
734
ADDRESS:6702 S. HOLT AVENUETELEPHONE:
(310) 251-1522
CITY:LOS ANGELESSTATE: CAZIP CODE:
90056
CAPACITY: 5CENSUS: DATE:
06/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:53 AM
MET WITH:Gabriela VazguezTIME COMPLETED:
12:30 PM
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On 06/2/23, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced Annual required visit with a primary focus on infection control measures, using the new Care Inspection Tool. LPA was met by Gabriela Vazquez, Administrator. Current census is 5.

Facility maintains a comfortable temperature. There is sufficient lighting throughout the facility including common areas and bedrooms. The Facility consist of 5 bedrooms and 2 bathrooms , living and dining rooms, kitchen, and service porch. Client bedrooms have the required furniture including bedframes and dresser drawers also have sufficient closet space. The bathrooms are clean and have the required equipment to meet the client’s needs. The water temperature measured at 107 F degrees.

Passageways are clear and free of obstructions. The front and backyard are well maintained. The backyard has patio furniture and a shaded area. The required generator is located in the backyard. There are no pools or large bodies of water. Cleaning supplies and toxicants are inaccessible to clients.

Con'd on 809 - C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: LADERA HOME 2
FACILITY NUMBER: 198601873
VISIT DATE: 06/02/2023
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The facility has medical professionals on shift and they are responsible for the gastrostomy feeding and medication administration. During the visit, staff and client’s files were reviewed. Medications were observed to be inaccessible to clients.

During the visit, LPA observed the facility infection control practices. LPA observed a screening station with sanitizer/soap in the facility and additional sanitation supplies in the garage inaccessible to the clients. LPA observed staff wearing mask. Each client has their own individual room for isolation and required postings are throughout the facility

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit.

Exit interview held. A copy of the report was provided.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2023
LIC809 (FAS) - (06/04)
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