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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603776
Report Date: 01/16/2025
Date Signed: 01/16/2025 10:52:15 AM

Document Has Been Signed on 01/16/2025 10:52 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:LOVE BEYOND WORDS RESIDENTIAL CARE IIFACILITY NUMBER:
198603776
ADMINISTRATOR/
DIRECTOR:		BROACH, BRIANAFACILITY TYPE:
735
ADDRESS:17906 CANEHILL AVE.TELEPHONE:
(562) 353-3228
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 4CENSUS: 0DATE:
01/16/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:42 AM
MET WITH:Briana Broach - AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Tena Herrera conducted an announced pre-licensing visit and met with Administrator Briana Broach and Licensee Debra Harding, for the purpose of conducting a Pre-Licensing Inspection / Component III visit.

The facility has an approved fire clearance to be licensed to serve a capacity of (4) Ambulatory Only Adults ages 18-59 years in rooms 1 & 2. (garage should not be used for living area)

This is a single-story home located in a residential area in Bellflower, Ca. A tour of the facility includes: 2 client bedroom, 2 full bathrooms, living room, family room, dining area, office area, laundry area, front yard, back yard and attached garage.

The physical plant was toured inside and out alongside Administrator and Licensee.



The following was observed/inspected:

· There is a locked storage cabinet for medication located in the office area.

· Cleaning supplies are kept separate from food and located in a locked cabinet.

· Facility walls, ceilings, floors, window screens and areas around the facility are clean and in good repair.

· Fire extinguisher and smoke detectors operate properly.

· Doors and passageways are free of obstruction.

· There are no pools/bodies of water at the facility and facility does not have firearms on premises.

· There is an emergency exiting plan with emergency phone numbers posted.

(Continued on 809-C)

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: LOVE BEYOND WORDS RESIDENTIAL CARE II
FACILITY NUMBER: 198603776
VISIT DATE: 01/16/2025
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 · There is a current disaster and mass casualty plan maintained at the facility.

· There is a plan for staffing arrangements and a designated cabinet where personnel files will are stored.

· Operating telephone and internet on the premises and will be available to residents.

· Residents Records have a designated area within a locked cabinet for safe keeping.

· There is a linen closet with extra linens and towels.

· Facility has a laundry area on premises.

· First-aid supplies are maintained and readily available.

· Refrigerator and freezer were observed and are maintained at the correct temperatures.

· Food storage and preparation are clean and appropriate for food preparation.

· Hot water temperature was tested and is within the required range of 105-120 degrees F.

Component III was completed during todays visit and reviewed by Licensee and Administrator.

An exit interview was conducted, and a copy of this report will be emailed to Licensee at masond09@yahoo.com and breebroachlbw@icloud.com

LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
LIC809 (FAS) - (06/04)
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