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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602216
Report Date: 07/15/2023
Date Signed: 07/18/2023 08:26:19 AM


Document Has Been Signed on 07/18/2023 08:26 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:FRANCESCA'S HOMEFACILITY NUMBER:
198602216
ADMINISTRATOR:COELLO, BESSIE LFACILITY TYPE:
740
ADDRESS:20520 AVIS AVENUETELEPHONE:
(310) 292-8425
CITY:TORRANCESTATE: CAZIP CODE:
90503
CAPACITY:6CENSUS: 6DATE:
07/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Director Bessie L. CoelloTIME COMPLETED:
12:00 PM
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On 07/15/23, Licensing Program Analyst (LPA) Lizeth Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Director Bessie L. Coello as the purpose of today’s visit was explained. The facility is licensed to serve 5 non-ambulatory of which 1 may be bedridden residents ages 60 and over. Room #4 bedridden only, hospice waiver approved for 2.

The facility is a single-story structure located in a residential neighborhood and consists of the following: The home consists of 4 Bedrooms, 2 Bathrooms, a linen closet, living room, dining area, kitchen, a stocked pantry, a small room that houses a washer and dryer, a refrigerator for staff, sharps container and locked medication. Toxins were observed to be locked and inaccessible to residents. There is a big outdoor shaded activity area, an attached garage that serves as storage unit as well as the Directors office.

LPA conducted a records review of 2 staff record, 2 resident records and 2 Medication Administration Records, LPA did not observe any discrepancies at the time of visit. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The last fire drill was conducted on 07/01/23, 1 fire extinguishers fully charged, carbon monoxide detectors observed, smoke detectors are operational, and a landline was observed.

All resident rooms were checked, mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed, alarm/censors on resident’s patio doors observed to be operational. Bathrooms were found to be within Title 22 regulation, toilets and water faucets worked properly, shower was free of mold/mildew, and there are sufficient toiletries accessible to residents. The water temperature properly measured between 105-120 F..
Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Exits/ Walkways around the facility were free of debris and hazards.
During today’s visit no discrepancies were cited, exit interview conducted with Director Bessie L. Coello, and a copy of this report was provided.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Lizeth VillegasTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2023
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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