198602390-10-31-2023-11-AS-WGIS-CX5VZT-20231031165316

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602390
Report Date: 10/19/2023
Date Signed: 10/31/2023 04:53:19 PM

COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/31/2023 04:53 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:	DANIELLA'S HOME		FACILITY NUMBER:	198602390
ADMINISTRATOR:	COELLO, BESSIE L		FACILITY TYPE:	740
ADDRESS:	18005 OSAGE AVENUE		TELEPHONE:	(310) 371-4088
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90504
CAPACITY:	6	CENSUS: 4	DATE:	10/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Bessie Coronado-Vigil		TIME COMPLETED:	05:14 PM

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On 10/19/23, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced annual visit using the full CAREs tool. LPA met with Administrator, Bessie Coronado-Vigil, and explained the purpose of today’s visit. Currently there are 4 Clients residing in the facility.

Structure/Physical Plant The facility is a two-story home in a residential neighborhood. The home consists of 4 bedrooms, 2 ½ bathrooms, family room, living room, kitchen, dining room, indoor and outdoor activity area, laundry room, front yard, and backyard. There is a shaded area with table and chairs. LPA observed a fenced pool on the premises. All walkways around the facility were observed to be clean, clear, and free of obstructions, hazards, and debris.

Bedrooms LPA inspected all client bedrooms and found them to be clean and in good repair. All rooms have the required furniture including a bed, dresser, nightstand, chair, and storage space for personal belongings. LPA observed all beds to have the required linens including a mattress cover, fitted sheets, blankets, comforter, and pillows. All bedrooms have ample lighting.

Bathrooms LPA inspected all bathrooms and found they were within Title 22 regulations. All bathrooms were observed clean and operational. LPA observed an adequate supply of towels and personal hygiene supplies. Secured handrails and non-skid mats were observed in both bathrooms.

Kitchen LPA observed the kitchen to be clean and sanitary. All appliances were tested and found to be in good working repair. LPA observed an ample supply of cutleries, pots, and pans in good repair. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods. A sample menu was posted on the refrigerator. All sharps were secured in a locked drawer in the kitchen and are inaccessible to client. All cleaning supplies were secured in a locked cabinet in the activity room and are inaccessible to clients. The water temperature measured 108.8-degrees Fahrenheit.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: DANIELLA'S HOME	FACILITY NUMBER: 198602390
	VISIT DATE: 10/19/2023

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Common Rooms In the living room, LPA observed two couches and chairs for client use. In the family room, LPA observed a couch available for clients. LPA observed games and activities in the family room. The dining room has a large table and chairs to accommodate all clients. LPA observed all walkways and hallways to be clean, clear, and free of obstructions and hazards. All rooms were observed with ample lighting. The facility was maintained at a comfortable temperature.

Safety Smoke and Carbon Monoxide Detectors are in compliance and are operational. LPA observed two fully charged fire extinguishers last serviced on 08/25/23. The last emergency drill was conducted on 08/25/23. The First Aid Kit was inspected and found to contain all required item and a manual. The facility has a working landline telephone. LPA observed all required documents posted throughout the facility. There are no firearms stored on the premises.

Files/Interview LPA reviewed 2 client files and found they contained the required documents. When interviewed, clients stated they were happy with the care they are receiving at the facility. LPA reviewed 2 staff files and found they contained the required documents, certification, and training. LPA interviewed 2 staff and all were able to answer questions regarding policy, procedures, and personal rights.

Infection Control LPA observe the facilities infection control procedures. LPA observed a sanitizing station and visitor log at the entrance of the facility. All clients, staff and visitors’ temperature is taken and logged upon entry. LPA observed staff wearing face coverings. All required infection control signs were posted throughout the facility. The facility has a 30-day supply of PPEs.

Medication LPA observed Centrally Stored Medications secured in a locked cabinet in the activity room and are inaccessible to clients. LPA reviewed medications and MAR for 2 clients and found them to be consistent.

During today’s visit no deficiencies were observed or cited.

An exit interview was conducted with Administrator, Bessie Coronado-Vigil, and a copy of this report was provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023

LIC809 (FAS) - (06/04)

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