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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602273
Report Date: 03/28/2022
Date Signed: 03/29/2022 07:12:35 AM

Document Has Been Signed on 03/29/2022 07:12 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:CHATEAU OF LIFEFACILITY NUMBER:
198602273
ADMINISTRATOR:ZANO, ROMEO UFACILITY TYPE:
735
ADDRESS:5007 W 119TH PLTELEPHONE:
(310) 722-7541
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY: 3CENSUS: 3DATE:
03/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Rose DurchholzTIME COMPLETED:
12:54 PM
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On 3/28/2022, Licensing Program Analyst (LPA) Ngozi Nwaokoro conducted an unannounced 1-year Annual Inspection at the Chateau of Life facility. LPA Nwaokoro met with facility staff Rose Durchholz. The Licensee Brenda Chander later joined us. LPA explained the purpose of the visit, 1-year Annual Inspection, with emphasis on infection control. Currently the home has (3) non-ambulatory clients, and at this time, there are (3) clients residing in the facility with Restricted Health Care conditions. All clients are between the ages of 18-59. As part of the inspection, LPA Nwaokoro reviewed: all three client service records, P & I records, client medication records and all personnel staff records, and inspected the inside facility and outside grounds.

LPA Nwaokoro and Licensee Brenda Chander toured the entire facility inside and outside grounds. The one story residential house consisted of (3) client bedrooms, (2) bathrooms, living room, family room, dining room, kitchen, and enclosed patio area. All facility rooms are clean and in good repair. LPA Nwaokoro observed the following during inspection of client rooms: mattresses and box springs in good condition, adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. LPA Nwaokoro observed fully stocked bedding and towel closet. LPA Nwaokoro observed bathrooms were found to be within Title 22 regulation. All bathroom fixtures are clean, in good repair, and working properly. LPA Nwaokoro observed there were sufficient bedding, linens, and toiletries accessible to clients. Water temperature properly measured at 113.7 degrees F for bathroom #1 (walk in shower) and 110.5 degrees F for bathroom # 2 perishable (7 day) and non-perishable (2 day) food supply were checked and are adequately stocked.

Report continued on form LIC 809-C.

SUPERVISORS NAME: Michael Cava
LICENSING EVALUATOR NAME: Ngozi Nwaokoro
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: CHATEAU OF LIFE
FACILITY NUMBER: 198602273
VISIT DATE: 03/28/2022
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Facility Carbon Monoxide and Smoke Detectors were tested. Both alert systems are working properly. The facility (2) Fire Extinguishers were fully charged and accessible. All toxins and knifes are locked/secured and inaccessible to clients. Medications are centrally stored and in a locked cabinet. Facility first aid kit was checked and in order. Outside grounds were toured and no bodies of water were observed. Outside patio accessible to clients. All Exits/ Walkways around the home were free of debris and hazards.


There were no deficiencies cited during todays visit.

A copy of the LIC 809 was given to the Licensee, Brenda Chander during the exit interview.
SUPERVISORS NAME: Michael Cava
LICENSING EVALUATOR NAME: Ngozi Nwaokoro
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2022
LIC809 (FAS) - (06/04)
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