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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603031
Report Date: 09/06/2024
Date Signed: 09/06/2024 12:03:44 PM

Document Has Been Signed on 09/06/2024 12:03 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:
09/06/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:08 AM
MET WITH:Administrator Andrea RobinsonTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On 09/06/2024 Licensing Program Analyst (LPA) Hollie Enriquez conducted a Case Management-Annual Continuation Visit at the above facility. LPA met with Administrator Andrea Robinson and the purpose of today's visit was explained. The facility is licensed to operate for six (6) ambulatory adults with Mental Illness ages 18 through 59. Currently the facility has six (6) clients in care.

LPA toured the kitchen area with Administrator and observed medication storage to be safe, locked, and inaccessible. All medications observed were labeled and maintained in compliance with label instructions according to State and Federal laws. First aid kits are fully stocked with manual. Smoke and carbon monoxide detectors were in compliance and operational. Documents are posted as mandated. Last Disaster drill was conducted on 08/17/2024. There is internet access and a video conferencing device dedicated for client use.

LPA reviewed six (6) client records, five (5) staff records, and two (2) client medications with MARs. LPA observed records and medication documentation to be in compliance.

No deficiencies have been cited. An exit interview was conducted and a copy of this report has been provided to Administrator Robinson.


SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Hollie Enriquez
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2024
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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