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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602012
Report Date: 10/30/2023
Date Signed: 10/30/2023 03:25:32 PM


Document Has Been Signed on 10/30/2023 03:25 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:C&H #7 RESIDENTIAL CARE FOR ELDERLYFACILITY NUMBER:
198602012
ADMINISTRATOR:ASHLEY ADLEANFACILITY TYPE:
740
ADDRESS:4702 EAST SAN VINCENTE STREETTELEPHONE:
(562) 630-8123
CITY:COMPTONSTATE: CAZIP CODE:
90221
CAPACITY:4CENSUS: 3DATE:
10/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Administrator assistant Rebekah JessersonTIME COMPLETED:
03:17 PM
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On 10/30/23, Licensing Program Analyst (LPA) Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Administrator assistant Rebekah Jesserson and explained the purpose of today’s visit. The facility is licensed to serve 4 ambulatory only elderly adults 60 and over, current census 3. Clients are linked to the South-Central Los Angeles Regional Center.

The facility is a single-story structure located in a residential neighborhood and consists of the following: (3) bedrooms, (1) full bathrooms, and 1/2 bath, linen closet, kitchen with a staff work area, shaded back yard, and a detached 2 garage that houses a washer and dryer and emergency water supply. There are no bodies of water nor firearms on the property, walkways are free of debris/hazards.

LPA conducted a records review of 2 staff records, 1 client records, and 1 medication administration record. No discrepancies observed. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The last fire was conducted on 10/02/23, fire extinguisher fully charged, carbon monoxide and smoke detectors observed and are operational. Landline and internet service was observed. Liability insurance active with expiration date of 02/06/2024.

Client bedrooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Bathroom toilets and water faucets worked properly, shower was free of mold/mildew, and there are sufficient toiletries accessible to clients. The water temperature properly measured between 105-120 F..

Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Toxins and knifes were observed to be stored and inaccessible to clients. Exits/ Walkways around the facility were free of debris and hazards.

During today’s visit no discrepancies were observed.

Exit interview conducted with Administrator assistant Rebekah Jesserson, and a copy of this report was provided.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lizeth VillegasTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/30/2023
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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