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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005402
Report Date: 05/12/2022
Date Signed: 05/12/2022 12:06:39 PM

Document Has Been Signed on 05/12/2022 12:06 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ENDEAVORS RESIDENTIAL CAREFACILITY NUMBER:
306005402
ADMINISTRATOR:PENALOSA, BRANDONFACILITY TYPE:
735
ADDRESS:9301 BIXBY AVENUETELEPHONE:
(310) 938-0700
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY: 4CENSUS: 4DATE:
05/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Enrique Manabat, Adminsitrator TIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into the facility by caregiver and LPA explained the nature of the visit. LPA met with Enrique Manabat, House Manager and explained the nature of the visit.

LPA Martinez began the tour of the inside and outside of the facility. There are four clients in care and there are no active covid-19 cases in facility. LPA observed one client in their bedroom having online classes and remainder of clients were out in day programs. LPA observed required department postings, covid-19 precautionary postings in the facility as well as hand washing signs throughout the facility. Restroom was observed to have a supply of soap and appeared to be clean. LPA inspected client’s bedrooms and appeared to be clean and sanitary. All bedrooms observed to have all required components. Client bedrooms are all private bedrooms. LPA observed a check in station in the main entry of the facility. Facility is taking temperature daily and documenting the results. LPA observed the emergency disaster and evacuation plan. Facility has a supply of emergency food and water supply as well as PPE supplies in the facility. LPA toured the outside of the facility and observed a shaded seating area for client’s enjoyment. A gated pool was also observed in the backyard. The facility has completed the LIC808 Mitigation Plan, LPA reviewed and approved the plan on today’s visit. LPA emailed the signed and approved plan to the Administrator for their records.

Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with the facility representative and a copy of this report was provided to the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2022
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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