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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602267
Report Date: 01/04/2024
Date Signed: 01/04/2024 11:45:46 AM

Document Has Been Signed on 01/04/2024 11:45 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:ENSLOW MANORFACILITY NUMBER:
198602267
ADMINISTRATOR:KIFLEZGHIE, JOVONNEFACILITY TYPE:
735
ADDRESS:20015 ENSLOW DRIVETELEPHONE:
(310) 933-8710
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 4CENSUS: 3DATE:
01/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Freda Duren, CaregiverTIME COMPLETED:
11:45 AM
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On 1/4/24, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced annual required visit with a primary focus on Infection Control measures. LPA was met by Caregiver Freda Duren and explained the purpose of today’s visit. The facility has a census of 3.

The facility is a one-story structure located in a residential neighborhood. The facility consists of (3) client bedrooms, (1) office, (1) client bathroom and (1) staff bathroom, living room, kitchen, dining area, office, patio, garage used for storage and laundry area. Facility maintains all required posting throughout the facility.

LPA Shirley and Freda walked through the kitchen and all appliances were in good working order. Knives were locked and stored in the medicine cabinet in the kitchen and inaccessible to residents. LPA observed a 3-day supply of perishable and a 7-day supply of nonperishable foods. The water temperature measured 117.9 degrees Fahrenheit.

Bedrooms 1-3 are occupied by residents and contain the mandated furniture. The (2) bathrooms have grab bars and are clean and operational. First aid kit is fully stocked with manual. No firearms are stored at facility and no bodies of water present. The facility is in good repair.

LPA Shirley and Freda walked through all common areas. In the living room, kitchen, dining room there is ample seating and space for all residents. All rooms and walkways were clean, and clear of obstructions and hazards. All areas have ample lighting. All rooms, hallway, and living room have working smoke detectors. There is a charged fire extinguisher in the kitchen and hallway. The backyard is clean and clear of obstructions and hazards and there are no bodies of water present.


An exit interview was conducted, and a copy of this report was provided to Caregiver Freda Duren.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2024
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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