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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602609
Report Date: 08/07/2023
Date Signed: 09/01/2023 07:42:07 AM

Document Has Been Signed on 09/01/2023 07:42 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:HANDS 2 HEARTSFACILITY NUMBER:
198602609
ADMINISTRATOR:DANIELS, JULIETFACILITY TYPE:
735
ADDRESS:15333 DAPHNE AVETELEPHONE:
(310) 266-7380
CITY:GARDENASTATE: CAZIP CODE:
90249
CAPACITY: 6CENSUS: 4DATE:
08/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Juliet DanielsTIME COMPLETED:
12:00 PM
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On 8/07/2023, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. The facility is licensed for six (6) non-ambulatory clients between the ages of 18-59. Todays census is 4.

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 bathrooms, dining area, kitchen, living room, office, activity room, storage room and back yard with shaded area.

LPA Shirley walked through all three (3) rooms. Bedrooms 1-3 are designated for the resident’s use. All bedrooms contained beds, dressers, nightstands, chairs, ample lighting and closet space. There is a storage room and LPA observed there to be 90 days plus PPE and food overflow. LPA observed the activity room located off backyard.

LPA walked through the kitchen and all appliances were in good working order. Knives were locked and stored in a drawer 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 at 112.2 degrees Fahrenheit.

All bathrooms were checked, sufficient liquid soap and paper towels were observed. Toilets and water faucets worked properly. The showers had grab bars and were free of mildew and mold. Bathrooms were found to be within Title 22 regulations and were clean and operational.



LPA walked through all common areas. In the living room, dining room and activity room there is ample seating and space for all residents. LPA observed games and activities for 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.

LPA walked the outside of the facility. In the back yard there are two tables with umbrellas with chairs for residents and visitors use. All walkways were clear of debris, obstructions and hazards. LPA did not observe any bodies of water.

No deficiencies were cited during this visit. An exit interview was conducted, and a copy of this report provided to administrator Juliet Daniels.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2023
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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