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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602866
Report Date: 07/05/2022
Date Signed: 07/05/2022 11:44:42 AM


Document Has Been Signed on 07/05/2022 11:44 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:SENIOR MANOR CARE IIFACILITY NUMBER:
198602866
ADMINISTRATOR:GRADNEY, ANGELIQUEFACILITY TYPE:
740
ADDRESS:1851 REDONDELA DRIVETELEPHONE:
(310) 989-1941
CITY:RANCHO PALOS VERDESSTATE: CAZIP CODE:
90275
CAPACITY:6CENSUS: 4DATE:
07/05/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:ADMINISTRATOR STEVEN GRADNEYTIME COMPLETED:
12:30 PM
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On 07/05/2022 around 12:00 PM Licensing Program Analyst (LPA) Jose Calderon conducted a Case Management -Other / Health and Safety Check visit to the facility listed above. Today’s visit was conducted face to face with Administrator Steven Gradney.

LPA Calderon conducted a physical tour which consisted of a review of the facility's living room, kitchen, backyard and 4 bedrooms and 2 bathrooms. LPA Calderon observed supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days maintained on the premises. LPA also observed
current supply of Medications kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. Corrections were made for drawer for room 2 and boxes were cleared for room 3. No other violations were found or noted for the above facility.

A exit interview was conducted with Administrator Steven Gradney and a hard copy was provided by hand for signature.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:
DATE: 07/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/05/2022
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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