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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608379
Report Date: 11/26/2024
Date Signed: 11/26/2024 04:17:27 PM

Document Has Been Signed on 11/26/2024 04:17 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:AVENIDA VILLA, INC.FACILITY NUMBER:
197608379
ADMINISTRATOR/
DIRECTOR:		PHILLIP ROMEROFACILITY TYPE:
740
ADDRESS:1803 AVENIDA FELICIANOTELEPHONE:
(310) 930-6455
CITY:RANCHO PALOS VERDESSTATE: CAZIP CODE:
90275
CAPACITY: 6CENSUS: 5DATE:
11/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:56 PM
MET WITH:May Drapeam, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:27 PM
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On 11/26/24 The Department of Social Services, Community Care Licensing Division (CCLD) staff conducted an unannounced annual inspection visit using the CARE Inspection Tool. CCLD staff was met by May Drapeau, Administrator (S1), and the purpose of the visit was explained. The facility is licensed for six residents, age 60 and over, of which five (5) may be non-ambulatory residents, along with one (1) bedridden resident. The facility has been approved for (2) hospice waivers and are compliant under California code of regulation 87705 – Care of persons with Dementia. The current census is five (5) residents. Facility fees are up to date and liability insurance is active with an expiration date of 07/16/25.

The facility is a single-story structure located in a residential neighborhood and consists of the following: (5) resident bedrooms, (2.5) resident bathrooms, living room, dining room, kitchen, staff room, office area, attached garage which contains a washer and dryer / storage area and an extra refrigerator. The facility also has a front and back yard with a shaded area with table and chairs. There are no weapons/ammunition stored on the premises and there are no bodies of water on-site. A supply of seven (7) day perishable and two (2) day non-perishable food was observed. Emergency Water supply is located in the garage. Toxins and knifes were observed to be stored and inaccessible to clients in care. Last fire drill was on 07/26/24. Carbon monoxide and smoke detectors were observed and are operational, a landline and internet were observed in working condition. The facility (2) Fire Extinguishers were checked and found to be fully charged, maintained annually as of 06/27/24. All exits and walkways are free of debris/hazards.

CCLD staff was not able to review any resident/staff records during today's visit.

There were no deficiencies observed or cited during today's visit.

An exit interview was held with May Drapeau (S1) and a copy of this report was provided.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE: DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/26/2024
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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