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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004187
Report Date: 05/14/2024
Date Signed: 05/14/2024 03:18:14 PM

Document Has Been Signed on 05/14/2024 03:18 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:SKY HOMES-DENMEADFACILITY NUMBER:
306004187
ADMINISTRATOR/
DIRECTOR:
SKY JULIANFACILITY TYPE:
735
ADDRESS:2409 DENMEAD STREETTELEPHONE:
(562) 455-5515
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY: 4CENSUS: 4DATE:
05/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:33 PM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
03:33 PM
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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit at the facility using the CARE Tool. LPA Mora met with Sky Julian (Administrator) and explained the reason for the visit. The facility is licensed to serve three (3) ambulatory and one (1) non-ambulatory developmentally disabled adults with restricted health conditions. The facility is operating within the scope of the license.

A tour of the single-story facility included the living room, den, kitchen, dining area, 4 client bedrooms, 2 bathrooms, laundry area, front yard, backyard, and detached garage. LPA Mora conducted a tour and observed the following: sufficient food supplies for at least 2 days of perishables and 7 days of non-perishables were observed in the kitchen. Sharps, chemicals and cleaning solutions are kept locked in a laundry cabinet. The First Aid kit is kept locked in the medication cabinet and it is fully stocked with all required items including a current manual. Clean towels and extra clean linen were observed in the hallway closet. Dining and living room have sufficient lighting and sitting area. Medications are kept locked in a laundry cabinet. Client and staff files are kept in a dining area cabinet. All bedrooms have all required furniture, lighting, and bedding. All bathrooms were observed with shower mats and grab bars for non-ambulatory clients. The water temperature was tested in both bathrooms and measured at 105.6 degrees F and 108.6 degrees F, which is within the required 105-120 degrees F. A fire extinguisher was observed in the kitchen and it is fully charged. Smoke detectors were observed throughout the facility and in each room and were operable during the visit. There is a carbon monoxide in the den and was operable during the visit. The front yard and backyard are clean. There is a shaded area with seating in the backyard. No bodies of water were observed at the facility. Passageways and exits are free of obstruction. LPA reviewed medication for all 4 clients and observed that medications are documented properly and given as prescribed. LPA reviewed files for all 4 clients and 5 staff files, and found no issues were found.

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 were provided.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Luis Mora
LICENSING EVALUATOR SIGNATURE: DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2024
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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