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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607718
Report Date: 05/02/2023
Date Signed: 10/17/2023 10:34:59 AM

Document Has Been Signed on 10/17/2023 10:34 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:CENTINELA ASSISTED LIVING CENTREFACILITY NUMBER:
197607718
ADMINISTRATOR:GWENDOLYN CRAIGFACILITY TYPE:
740
ADDRESS:1000 S FLOWER STTELEPHONE:
(310) 674-3216
CITY:INGLEWOODSTATE: CAZIP CODE:
90301
CAPACITY: 96CENSUS: DATE:
05/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:49 AM
MET WITH:Gwendolyn CraigTIME COMPLETED:
04:00 PM
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On 5/2/23, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA met with Elizabeth Hernandez, Social Worker, explained the purpose of today’s visit and were allowed entrance to the facility. The facility is an RCFE licensed for (60) ambulatory and (36) non- ambulatory residents. Facility has no hospice waiver. LPA and staff were later joined by administrator Gwendolyn Craig.

The facility is a one-story structure located in a residential neighborhood. LPA Shirley and Administrator Gwendolyn Craig toured the physical plant.

LPA observed the kitchen to be clean and sanitary and all appliances were operable. The facility has a sufficient supply of perishable and non-perishable foods. The pantry was well stocked. The refrigerators were clean and well stocked. LPA observed a shaded patio. During the visist, LPA observed all staff were wearing face coverings.

An exit interview was conducted and a copy of this report was left with the Administrator Gwendolyn Craig, whose signatures on this form confirm receipt of these documents.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2023
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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