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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603613
Report Date: 03/06/2024
Date Signed: 03/06/2024 03:43:51 PM

Document Has Been Signed on 03/06/2024 03:43 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:STAR VIEW RANCHO LOS AMIGOS CRTFACILITY NUMBER:
198603613
ADMINISTRATOR:LOZANO, AIDA YVONNEFACILITY TYPE:
772
ADDRESS:7755 LEEDS STREETTELEPHONE:
(562) 719-2867
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 16CENSUS: 4DATE:
03/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:43 PM
MET WITH:Jbenga SowunmiTIME COMPLETED:
03:50 PM
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Licensing Program Analyst, (LPA) Sanjay Vaid conducted an announced visit to this location, for the purpose of conducting a one-year annual visit. On today's visit, LPA was greeted by Karla Portillo who allowed entry into the facility. Administrator Gbenga Sowunmi was notified and met with LPA for the facility tour. The capacity of sixteen(16) clients, of which zero (0) may be non-ambulatory and zero (0) bedridden. Todays census is 5(five) clients.
Structure/Physical Plant: Facility is a two-story building with a reception, lobby area, laundry room with washer and dryer on both floors, the facility has central air and heating, hygiene room, nurse assessment room, food storage room, medication room for storing and locking medications, living room/visiting rooms, kitchen, janitors closet, Large Storage room, living room/visiting room, computer areas, multipurpose room, dining area, lounge area, staff office, staff lounge, employee patio area, (2) staff stations (1) on each floor. The outdoor grounds were not toured due to rain. There is a designated shaded patio area with table and chairs accessible for resident use.
Accommodations: Adequate accommodations observed throughout facility. Lighting: Sufficient Lighting throughout. Hallway and Doorways: Free and clean of obstruction and debris. Resident Rooms: Bedrooms #1-#8 are for (2) ambulatory clients each. All bedrooms are equipped with overhead lighting, (2) chairs, night stands, lamp in addition to overhead lighting, large drawer, and closet space. Bathrooms: Client Bathroom #1-8 observed. (4) of (8) restrooms have the shower in a separate room from the toilet. There are (2) restrooms designated for staff use. Restrooms have a working toilet, wash basin, shower, grab bars and nonskid mats. Smoke Detectors & Fire Extinguishers: Detectors Electrical & connected. Smoke detectors and carbon monoxide detectors observed, all detectors tested and operational. Toxins: Locked/stored for staff use only. Hot Water Temperature: Measured between 105 -120 degrees all around the building. Reading Material, Games, Equipment & Materials, Postings: The facility has activity supplies and an activities calendar posted. Required wall postings observed. Bodies of Water: None. Pets: None.
No deficiencies were observed. Due to time constraints only the Physical Plant and Environment Safety was completed today, LPA will return to facility another day to complete the annual in its entirety.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2024
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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