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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602609
Report Date: 08/18/2021
Date Signed: 08/18/2021 04:21:50 PM

Document Has Been Signed on 08/18/2021 04:21 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME:HANDS 2 HEARTSFACILITY NUMBER:
198602609
ADMINISTRATOR:DANIELS, JULIETFACILITY TYPE:
735
ADDRESS:15333 DAPHNE AVETELEPHONE:
(310) 266-7380
CITY:GARDENASTATE: CAZIP CODE:
90249
CAPACITY: 6CENSUS: DATE:
08/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Amaka Uzo and Juliet DanielsTIME COMPLETED:
04:25 PM
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On 8/18/2021, Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA met with assistant Amaka Uzo and explained the purpose of today’s visit. The facility is licensed for six (6) non-ambulatory clients between the ages of 18-59.

The facility is a single-story home located in a residential neighborhood. The facility consists of the following: three (3) resident bedrooms, two (2) resident bathroom, dining area, kitchen, living room, laundry room, office, activity room, storage room and back yard patio with tables, chairs and shaded area.

LPA Cifuentes and staff Amaka Uzo toured the physical plant. There were no obstructions on the premises or small bodies of water found. Beds and bedding supplies were in good condition, adequate lighting provided, storage for client personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational.

LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage area cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Four (4) smoke detectors were observed to be hardwired and interconnected. Facility has two fire extinguishers, both fully charged.

During the visit, LPA observed the facility infection control practices. LPA reviewed screening protocol for visitors, staff, and residents, sanitizing stations in common areas and restrooms, temperature and symptom logs for clients and staff as well as surveillance testing . LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted and available.

No deficiencies were cited during this inspection visit.

An exit interview was conducted and a copy of this report was provided to Juliet Daniels.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2021
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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