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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609364
Report Date: 08/08/2024
Date Signed: 08/08/2024 12:20:52 PM

Document Has Been Signed on 08/08/2024 12:20 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:SANTA MONICA HOME & CARE 3FACILITY NUMBER:
197609364
ADMINISTRATOR/
DIRECTOR:		GARY STRATHEARN/JENNIFER BFACILITY TYPE:
740
ADDRESS:910 10TH ST UNIT B AND FRONTTELEPHONE:
(310) 576-0044
CITY:SANTA MONICASTATE: CAZIP CODE:
90403
CAPACITY: 6CENSUS: 3DATE:
08/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:12 AM
MET WITH:Administrator Gary StrathearnTIME VISIT/
INSPECTION COMPLETED:
12:35 PM
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On 08/08/2024 at 8:12 am Licensing Program Analyst (LPA), David España conducted an unannounced annual visit using the full CAREs tool. Upon arrival at the facility, LPA España conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection. LPA verified that the facility has an approved mitigation plan report. LPA was granted access and allowed to enter the facility to conduct the inspection. LPA was met by Gary Strathearn Administrator and the purpose of today’s visit was explained. Facility is a four-bedroom, three-bathroom, apartment unit in a shared building.

There is a kitchen, dining room, and a common area with a couch and TV. Outdoor area contains a patio, garden, and a detached storage garage for supplies. All indoor and outdoor passageways were free of obstruction, and perimeter gates were unlocked. No accessible hazards were observed. There are four client bedrooms, each currently set up for single occupancy. Bedrooms are adequately furnished and clean. There are no staff rooms in this facility. All bathrooms have clean and working toilets, wash basins, and showers.

LIC 809-C (cont)

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2024
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: SANTA MONICA HOME & CARE 3
FACILITY NUMBER: 197609364
VISIT DATE: 08/08/2024
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Beds have the required linens and extra supplies of linens and hygiene items are available. Facility has a facility land line (310) 576-0044 and family and resident land line (310) 310-3931, disaster plan is posted and available for review in hallway, fire extinguisher located in common area is charged. Licensee has a waiver to utilize this kitchen for a total of four facilities. Dishes, cups and flat were are stored in kitchen cupboards, inspected and in good repair. Knives and other sharps are kept in a locked drawer. An adequate supply of perishable and emergency foods was observed to be properly stored on site. Dishwasher and all other appliances are functioning properly. During the facility tour focusing on the Physical Plant and Environmental Safety, Gary Strathearn Administrator, and a Licensing Program Analyst (LPA) David España conducted a thorough inspection of the premises. The primary objective was to assess the facility's compliance with safety standards and ensure that all equipment was functioning properly. Key Observations:
1. Refrigeration and Freezer Units:
- A total of three refrigerators and three freezers were inspected during the tour.
- Two of these refrigerators were located in the garage and facility area.
- The remaining refrigerators and freezer were situated in the basement,
Purpose of the Inspection:
- Safety Compliance: The tour aimed to verify that all refrigeration units were operating within safe temperature ranges to prevent spoilage and ensure food safety.
LIC 809-C (cont)
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
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: SANTA MONICA HOME & CARE 3
FACILITY NUMBER: 197609364
VISIT DATE: 08/08/2024
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- Equipment Condition: The condition of the refrigerators was assessed to ensure they were well-maintained and free from any potential hazards.
- Environmental Safety: The placement and operation of these appliances were reviewed to ensure they adhered to environmental safety standards, minimizing risks such as electrical hazards or improper ventilation. LPA tested 6 battery-operated smoke/carbon monoxide detectors; all were functioning properly. Stove burners, dish washer, microwave and refrigerator were all working properly. Facility has working central air. LPA did not observe any accessible hazards during inspection. Chemicals are to be locked in a secure designated cabinet in the common area. Water temperature tested at 115 degrees Fahrenheit throughout the facility. A first aid kit was inspected which had a thermometer, tweezers, scissors, antiseptic, bandages, gauze and current first aid manual. Medications are stored in locked cabinets in the common area. All staff and client records are secured in filing cabinets, facility does not handle client funds. facility has board games, books, and other recreational materials for the clients use. No bodies of water are present.
Fire clearance for 4 ambulatory and 2 non-ambulatory residents was approved on 4/25/17. Facility was observed to be operating within the limits of this license during visit. Perimeter gates and exits are locked and do not contain delayed egress devices. Alert signals are located on all exits.

An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Administrator Gary Strathearn.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
LIC809 (FAS) - (06/04)
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