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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603689
Report Date: 03/11/2024
Date Signed: 03/11/2024 04:04:31 PM

Document Has Been Signed on 03/11/2024 04:04 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ALONDRA HOMEFACILITY NUMBER:
198603689
ADMINISTRATOR:CALHOUN, JAMESFACILITY TYPE:
735
ADDRESS:11403 ALONDRA BLVDTELEPHONE:
(310) 987-9397
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 4CENSUS: 4DATE:
03/11/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:James CalhounTIME COMPLETED:
02:30 PM
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Licensing Program Analyst(LPA) Nicol Wesley conducted a pre-licensing inspection and met with Applicant designee James Calhoun, Shameric Allen, Ebony Brown. The facility will be licensed as an Adult Residential facility to serve 4 ambulatory consumers within the age of 18-59 years. There are 4 clients in care. The facility phone number is 562 864 3121. The Prelicensing care tools were used.

LPA Wesley toured the facility and observed the following: Front yard, Dining area, Living room, Den, 4 bedrooms, 2 bathrooms, 1 office, kitchen, washer and dryer, back yard with an area for shade(canopy/table/chairs). Hot water was tested and the temperature measured at degrees F. Medications, medication records, and first aid kit with manual will be centrally stored in a locked office cabinets, toxins, detergents, and sharps, are stored in a locked office cabinets. Linen, towels, and PPE supplies, were observed in a closet in hallway. The smoke detectors/carbon monoxide detectors were tested and are operable. 1 fully charged fire extinguishers(1 in dinning). LPA observed an adequate supply of perishable and non perishable food items, as well as an emergency supply of food and water located in the office.

Component III Orientation with Applicant designee is waived as the applicant designee has completed it in the past. LPA observed all the required postings as mandated including infection control/PPE station. Administrator Certificate(ARF) James L Calhoun #6030677735 expires 05/13/2024.

The following items are needed prior to licensure:
  • CAB(Centralized Application Bureau) to finalize application.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Nicol Wesley
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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