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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602258
Report Date: 09/09/2022
Date Signed: 09/09/2022 02:13:59 PM

Document Has Been Signed on 09/09/2022 02:13 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:VELMA'S GUEST HOMEFACILITY NUMBER:
198602258
ADMINISTRATOR:BAILEY, DENISEFACILITY TYPE:
735
ADDRESS:2824 W 108TH STREETTELEPHONE:
(323) 757-7736
CITY:INGLEWOODSTATE: CAZIP CODE:
90303
CAPACITY: 6CENSUS: 0DATE:
09/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:36 PM
MET WITH:Danette YoungerTIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Perry Scott conducted an unannounced Required - 1 Year visit. LPA Scott met with staff Danette Younger and spoke to the Cynthia K. Buford, via telephone. LPA Scott, informed staff that the purpose of today's visit was to conduct the facility annual inspection, review the facility physical plant, medications, food service, clients, and staff records. The facility annual fees are current. The facility currently has zero (0) consumers in placement.

The facility is a single-story home located in a residential neighborhood. Ms. Younger and LPA Scott made a complete tour of the facility which included: Living room, dining room, family room, office, kitchen, breakfast area, pantry, 5 bedrooms, 3 bathrooms, laundry room, storage room, detached garage, patio/shaded area, indoor/outdoor activity areas. Four (4) of the bedrooms have been turned into offices.

Documents were posted as mandated on the wall in the living room and breakfast area. The following Title 22 regulated areas were audited and found to be complying: One Bedroom contained the required furniture and were inspected for safety, privacy, and comfort. The other bedrooms have been turned into offices. The living areas are clean, bathrooms are clean and operational. First aid kit is fully stocked with manual, hot water temperature measured 110 degrees Fahrenheit, working telephone, smoke and carbon monoxide detectors were complying, fire extinguisher is fully charged. No firearms on the premises, all exit doors were complying, covered trash cans, and no bodies of water present. Hazardous items are inaccessible to clients, although they don’t have clients currently. The yard is free of debris and hazards.

There were no deficiencies cited. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Danette Younger.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2022
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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