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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603049
Report Date: 03/10/2025
Date Signed: 03/11/2025 02:41:11 PM

Document Has Been Signed on 03/11/2025 02:41 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:MATHARU HOME #1FACILITY NUMBER:
198603049
ADMINISTRATOR/
DIRECTOR:		GALEANO, ADRIANAFACILITY TYPE:
735
ADDRESS:15227 ROSELLE AVETELEPHONE:
(310) 328-8482
CITY:LAWNDALESTATE: CAZIP CODE:
90260
CAPACITY: 6CENSUS: 4DATE:
03/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:24 PM
MET WITH:Adriana Galeano, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 3/10/25, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced required annual visit using the full CAREs Inspection Tool. LPA met with the Administrator, Adriana Galeano and explained the purpose of today’s visit. The facility is licensed to serve developmentally disabled adults ages 18 thru 59 years old.

LPA reviewed all resident files and five (5) staff files and found they did contain all required documents. During file review, LPA observed the surety bond.

LPA Felisa and Adriana toured both inside and outside of the facility. The facility is a one-story structure located in a residential neighborhood. The facility consists of (4) client bedrooms, (2) bathrooms, living room, kitchen, dining area, and patio. Facility maintains all required posting throughout the facility.

All bedrooms were toured. Bedrooms 1-4 are occupied by residents and contain the mandated furniture. LPA observed all rooms to have the required furniture including a bed, dresser and chair(s). All beds had the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillow. LPA observed ample lighting in all the bedrooms and hallway.

LPA Shirley and Adriana toured the kitchen and found it to be clean and sanitary. All appliances were in good working order. Knives were locked and stored in a drawer in the kitchen. The medications were locked and stored in the cabinet located in the dining room. LPA observed a 3-day supply of perishable and a 7-day supply of nonperishable foods. The water temperature measured at 107.5.


Con'd on 809-C
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: MATHARU HOME #1
FACILITY NUMBER: 198603049
VISIT DATE: 03/10/2025
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The bathroom was clean and operational. First aid kit is fully stocked with manual. No firearms are stored at facility and no bodies of water present.

LPA Shirley and Adriana walked through all common areas. In the living room, kitchen, dining room there is ample seating and space for all 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. There is a charged fire extinguisher in the living room. The backyard is shaded, clean and clear of obstructions and hazards, and there are no bodies of water present.

There were no deficiencies observed.


An exit interview was conducted, and a copy of this report and appeals rights was provided to the Administrator, Adriana Galeano.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025
LIC809 (FAS) - (06/04)
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