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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602924
Report Date: 01/03/2024
Date Signed: 02/07/2024 11:48:22 AM


Document Has Been Signed on 02/07/2024 11:48 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:RICH RESIDENTIAL CARE LLC 2FACILITY NUMBER:
198602924
ADMINISTRATOR:RICHARDSON, GENTRYFACILITY TYPE:
740
ADDRESS:2030 W. 94TH PLACETELEPHONE:
(310) 350-1123
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY:4CENSUS: 4DATE:
01/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Administrator Gentry RichardsonTIME COMPLETED:
05:00 PM
NARRATIVE
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On 01/03/2024 at 1 :47 pm Licensing Program Analyst (LPA) David Espana conducted an unannounced Required-1-year annual visit. Upon arrival at the facility, LPA Espana conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection (No COVID-19 cases). LPA verified that the facility has an approved mitigation plan report. LPA was granted access and allowed to enter the facility to conduct the inspection. The Residential Care Facilities for the Elderly (RCFE) facility is licensed for age range 60 and over, two (2) ambulatory and two (2) non-ambulatory in room #3 only.The Annual Licensing Fees are current. The facility is a story single-family home located in a residential neighborhood. The home consists of one (1) floor, three (3) resident rooms, one (1) office, two (2) restrooms, one (1) kitchen, one (1) dining room, one (1) living room. Administrator Gentry Richardson accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed.
Exits/walkways around the home were free of debris and hazards and no locks were found on exits. Patio furniture under a shaded area behind house was accessible to clients. There are no weapons on the premises. There were no security bars on the windows. LPA toured the kitchen area and observed a two-day (2-day) supply of perishable and a seven-day (7-day) supply of non-perishable food. A fire/emergency drill was conducted on 12/11/2023. All three resident bedrooms had the required furniture, bed linens and
closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and non-skid mats were in place. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked in hall cabinets. Hot water temperature in bathroom 1 tested and kitchen both read 109.2 Fahrenheit. Two technical assistance provided today: Resident Rights/Information - Technical Assistance: 87468(c)(2)(A) - LPA and the Administrator did not observe PUB 475 (20"X26") at the front entryway of the facility. Disaster Preparedness - Technical Assistance: 1569.695(a)(5) - LPA and the Administrator did not observe the updated LIC610E. An exit interview was conducted. A copy of this report was discussed and left with Administrator Gentry Richardson.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 01/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2024
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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