198602413-1-21-2024-11-AS-ARID-CZPQTU-20240121112742

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602413
Report Date: 01/21/2024
Date Signed: 01/21/2024 11:27:50 AM

Document Has Been Signed on 01/21/2024 11:27 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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME:	LA'DELIA RESIDENTIAL HOME		FACILITY NUMBER:	198602413
ADMINISTRATOR:	OIKHALA, PERPETUAL		FACILITY TYPE:	735
ADDRESS:	7023 DENVER AVE		TELEPHONE:	(323) 305-1971
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90044
CAPACITY:	4	CENSUS: 4	DATE:	01/21/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:02 AM
MET WITH:	PERPETUAL OIKHALA		TIME COMPLETED:	11:45 AM

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On 01/21/2024, Licensing Program Analyst (LPA) Antonine Richard made and unannounced inspection to La ‘Delia Residential Home, for the required annual inspection, using the new CARE Inspection Tool. On today’s visit LPA met with Perpetual Oikhala, the Administrator, and the purpose of the visit was explained. The facilities annual fees are current.

The facility has a capacity for four (4) clients. Currently, the home has 4 ambulatory clients, and none have a restricted health care condition, and all clients are between the ages of 18-59. As a part of the inspection, my primary focus was on infection control. LPA observed the facility’s infection control practices: LPA observed a sanitizing station at the facility entrance. PPE supplies are readily available to staff, and additional supplies are stored. Sufficient paper, cleaning, and disinfecting supplies were observed. And the facility has the mandated COVID infection control posters.

LPA Richard and Administrator Oikhala toured the entire facility inside and out. The home consists of 4 client bedrooms, 2 bathrooms, living room, kitchen, and dining area. All client rooms were checked. Mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Walls and floors were clean and in good repair. Bed linens, comforters and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulation. Toilets and water faucets worked properly. Shower was free of mold/mildew, adequate lighting, and sufficient toiletries accessible to clients. Water temperature measured at 105. 6F degrees F and within title 22 regulations.

Continued on LIC 809C

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonine Richard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: LA'DELIA RESIDENTIAL HOME	FACILITY NUMBER: 198602413
	VISIT DATE: 01/21/2024

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Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Carbon monoxide detector was operational. Smoke detectors were working properly, fire extinguishers were fully charged and operational, toxins and knifes were locked and inaccessible to clients. Medications were centrally stored and properly locked, first aid kit was checked an in order with manual. Outside grounds were toured and no bodies of water were observed. Exits/ Walkways around the home were free of debris and hazards.

During the visit, LPA observed the following to be complying: the facility's infection control practices; every staff was wearing a face covering; the facility has a 90-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has a Mitigation Plan Report approved by CCLD.

LPA advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing website (cdss.ca.gov) for Provider Informational Notices (PIN) and for any updates relating to COVID-19 guidance.

No Deficiencies Cited

Exit Interview Conducted and a copy of the Facility Evaluation Report was given to Perpetual Oikhala.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonine Richard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2024

LIC809 (FAS) - (06/04)

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