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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603031
Report Date: 08/14/2024
Date Signed: 08/15/2024 10:53:46 PM

Document Has Been Signed on 08/15/2024 10:53 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:ANZAC RESIDENTIAL CAREFACILITY NUMBER:
198603031
ADMINISTRATOR/
DIRECTOR:
ROBINSON, ANDREAFACILITY TYPE:
735
ADDRESS:12323 S ANZAC AVETELEPHONE:
(310) 901-5428
CITY:COMPTONSTATE: CAZIP CODE:
90222
CAPACITY: 6CENSUS: 6DATE:
08/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:16 PM
MET WITH:Administrator Andrea RobinsonTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 08/14/2024, Licensing Program Manager (LPM) Ulysses Coronel and Licensing Program Analyst (LPA) Hollie Enriquez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Andrea Robinson, Administrator and Leonard Walton, Caregiver and the purpose of today’s visit was explained. The facility is licensed to operate for (6) ambulatory adults with Mental Illness ages 18 through 59. Currently, the home has (6) clients.

The facility is a single-story home located in a residential neighborhood. The property consists of the following: living room, kitchen, dining room, 4 bedrooms, 2 bathrooms (1 for staff), laundry area, garage, front and back yard.



LPA and LPM toured the physical plant with Caregiver Walton. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for resident personal belongings is available. Bed linens, comforters, and bath towels were adequately stocked at the time of the visit. Bathrooms were found to be within Title 22 regulations. Toilets and water faucets worked properly. Shower was free of mold/mildew, there is adequate lighting, and sufficient toiletries accessible to clients. The water temperature measured 105.8F.

LPA and LPM observed the facility to be sanitary and appropriately furnished at the time of the visit. Storage areas for personal hygiene were stored and not accessible to residents. The kitchen was inspected and there is a 2 days supply of perishable and 7 days supply of non-perishable food available at the time of the visit. Fire extinguisher in kitchen was fully charged, toxins and sharps were locked and inaccessible to clients. Medications were centrally stored and properly locked. A working landline telephone remains available. The Facility Disaster and Infection Control Plans were current and in compliance with Title 22 at the time of visit.

LPA and LPM conducted a records review of five(5) staff records.

No deficiencies were cited during today's visit. An exit interview was conducted. Due to time constraints, an unannounced Case Management-Annual Continuation visit will be conducted.

An exit interview was conducted and copy of this report has been provided to the Administrator.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Hollie Enriquez
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2024
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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