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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004187
Report Date: 06/29/2022
Date Signed: 06/29/2022 01:18:15 PM

Document Has Been Signed on 06/29/2022 01:18 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:SKY HOMES-DENMEADFACILITY NUMBER:
306004187
ADMINISTRATOR:SKY JULIANFACILITY TYPE:
735
ADDRESS:2409 DENMEAD STREETTELEPHONE:
(562) 455-5515
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY: 4CENSUS: 4DATE:
06/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:14 AM
MET WITH:Adminisrtator, Julian SkyTIME COMPLETED:
01:32 PM
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On 6/29/22 at 11:11 a.m., Licensing Program Analysts (LPA) Jewel Baptiste conducted an unannounced visit for the purpose of conducting the required annual inspection. On today's visit LPA met with Administrator, Sky Julian who assisted with the visit.

The Facility is licensed to served 4 clients between the age of 18 and 59 years old which shall be ambulatory. The facility is a single-story building in a residential area, with 4 bedrooms, 2 bathrooms, a commercial kitchen, dining room, family room, detached garage, and a backyard with shaded sitting area. The facility is vendorized through Harbor Regional Center. Facility carbon monoxide/ smoke detectors were tested and in working condition.

LPAs discussed infection control practices with administrator, toured the facility inside and out, reviewed food supply, reviewed staff files, and reviewed resident medications

Report continued on 809c

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2022
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: SKY HOMES-DENMEAD
FACILITY NUMBER: 306004187
VISIT DATE: 06/29/2022
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All bedrooms have the required furniture including bedframes, dressers, lamps, and chairs. Beds have the required linen and the linen is in good condition. Passageways and exits are free of obstruction. The front and backyard are well maintained. The resident bathrooms are clean, and showers have non-skid materials. The hot water temperature measured at 112.9- 114.7 degrees F. There is sufficient lighting throughout the facility. There are smoke detectors located throughout the facility, tested and operational. The kitchen was adequately stocked, sufficient food supplies viewed with 7 days of nonperishable and 2 days of perishables. LPA observed a sufficient supply of PPE in office and in garage. Infection control signs were observed throughout the facility. Facility files was complete. Administrator certificate expire 10/10/2023 #6003571735. Emergency disaster drill last conducted 3/21/22.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided to administrator Sky Julian.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
LIC809 (FAS) - (06/04)
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