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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191601495
Report Date: 09/05/2024
Date Signed: 09/05/2024 04:37:05 PM

Document Has Been Signed on 09/05/2024 04:37 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:W.L.A. HOMESFACILITY NUMBER:
191601495
ADMINISTRATOR/
DIRECTOR:		SAM MAGHAZEIFACILITY TYPE:
740
ADDRESS:11373 CHARNOCK RD.TELEPHONE:
(310) 915-9196
CITY:LOS ANGELESSTATE: CAZIP CODE:
90066
CAPACITY: 6CENSUS: 4DATE:
09/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Sam Maghazei - Licensee, Minnie Joy Membrebe - AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
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On 09/05/2024, Licensing Program Analyst (LPA) Troy Watson conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with the Licensee Sam Maghazei and the Administrator Minnie Joy Membrebre. LPA explained the purpose of today’s visit. Facility is licensed for (6) non-ambulatory residents and (2) bedridden residents. The facility has an approved hospice waiver for (2) residents.The facility consists of (4) resident bedrooms, (3) bathrooms, (1) living room, (1) dining room, and (1) kitchen.

LPA Troy Watson toured the physical plant with the Licensee. There were no bodies of water or obstructions on the premises. A total of (3) rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident’s personal belongings was observed. Bathrooms were found to be within Title 22 regulations and were operational. LPA inspected (6) six smoke/carbon monoxide detectors,that were in operable condition. The water temperature properly measured between : 111.3 F and 111.6 F.

Evaluation Report Continues LIC809-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: W.L.A. HOMES
FACILITY NUMBER: 191601495
VISIT DATE: 09/05/2024
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LPA Troy Watson observed the facility to be clean, sanitary, and appropriately furnished at the time of the visit. Storage areas for personal hygiene were observed. Sharps objects and cleaning agents were locked and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available at the property. All fire extinguishers were charged and were operable. A review of (4) residents' service files, (4) staff personnel files were reviewed. LPA checked (4) Medication Administration Records (MAR) and no discrepancies were found. The first AID kit was checked and contained the correct manual. Last facility disaster drill was held in June 2024.LPA observed the facility's infection control practices. And copy of the liability insurance was on file.

An exit interview was conducted, with the administrator and licensee and a copy of the Facility Evaluation Report was provided

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC809 (FAS) - (06/04)
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