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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603334
Report Date: 09/19/2024
Date Signed: 09/19/2024 03:31:14 PM

Document Has Been Signed on 09/19/2024 03:31 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:ROSEVIEW TERRACEFACILITY NUMBER:
198603334
ADMINISTRATOR/
DIRECTOR:		CHAVEZ, KARENFACILITY TYPE:
735
ADDRESS:15607 S VISALIA AVETELEPHONE:
(310) 327-5660
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY: 6CENSUS: 4DATE:
09/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Sherese ButlerTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 9/19/24, at 1:00pm, Licensing Program Analyst (LPA) Perry Scott made an unannounced inspection to Roseview Terrace. The purpose of today’s visit was to conduct the required annual inspection, using the new Care Tool. LPA was met by Sherese Butler, House Manager, and the purpose of the visit was explained. The facility is licensed to serve six (6) developmentally disabled clients (age 18-59) of which six (6) may be non-ambulatory. Currently, the home has (4) clients. The clients are South-Central Los Angeles Regional Center clients. The facilities’ annual fees are due on 11/19/24 for $454.00.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: 3 bedrooms, 2 bathrooms, family room/dining room, kitchen, living room, office, shaded area, indoor and outdoor activity area, laundry room and an attached garage.

LPA conducted a records review of (4) client record, (6) staff records, and reviewed the facility disaster plan. All client & staff records were complete. The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (4) Client Medication Administration Records and did not observe any discrepancies at the time of visit.

At 1:15pm, LPA and Sherese Butler toured the physical plant. All resident rooms were checked. Beds and bedding were in good condition, adequate lighting provided, adequate storage for client personal belongings was observed. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations. Toilets and water faucets worked properly. The shower was free of mold/mildew, there is adequate lighting, and sufficient toiletries accessible to clients. The water temperature measured 110.8F. A comfortable temperature is maintained in the facility.

Report continued on LIC 809-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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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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: ROSEVIEW TERRACE
FACILITY NUMBER: 198603334
VISIT DATE: 09/19/2024
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LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for cleaning agents, toxins, and sharps were inaccessible to clients. The kitchen was inspected and there is enough perishable and non-perishable food available, which is stored properly. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. The fire extinguisher was charged, and smoke/ carbon monoxide detectors were operable. The last fire/emergency drill was conducted on 08/15/2024.

During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents. LPA observed that sanitizing stations were in common areas and restrooms. LPA observed that the facility had the required postings, posted throughout the facility. LPA further observed the facility to have a 60-day supply of Personal Protective Equipment (PPE).

LPA advised the administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing (www.cdss.ca.gov) for Provider Informational Notices (PIN) and for any updates relating to COVID-19 guidance and other related issues.

LPA did not observe any deficiencies; therefore, no citations were issued at this time.

An exit Interview was conducted, and a copy of the Facility Evaluation Report was given to Sherese Butler, House Manager.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC809 (FAS) - (06/04)
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