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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198204399
Report Date: 10/03/2024
Date Signed: 10/03/2024 02:37:12 PM

Document Has Been Signed on 10/03/2024 02:37 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:VILLA REDONDO CARE HOMEFACILITY NUMBER:
198204399
ADMINISTRATOR/
DIRECTOR:		MARIA BRAVOFACILITY TYPE:
740
ADDRESS:237 REDONDO AVENUETELEPHONE:
(562) 434-9931
CITY:LONG BEACHSTATE: CAZIP CODE:
90803
CAPACITY: 80CENSUS: DATE:
10/03/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:52 AM
MET WITH:David Hernandez, Assistant AdminstratorTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On 10/03/2024 at 8:15 am , LPA Zina Brown conducted an unannounced continuation annual visit using the CARE Inspection Tool. LPA met David Hernandez (Assistant Administrator) with the purpose of today’s visit was explained. The annual facility fee renewal is a balance of $0. Liability Insurance Policy (Policy # IYG426175E) is current and valid from 08/06/2024 - 08/26/2025 and as followed occurrence at $1,000,000 and general aggregate at $3,000,000.

Upon document review by LPA, the inspection and drills were conduct:
  • Fire Marshall Inspection on 11.21.2023
  • Fire Drill & Disaster Drill 09.13.2024
Fire extinguisher are fully charged and were inspected on 09.09.2024. Carbon monoxide and smoke detector are operational.

In the following residents rooms, water temperature tested at:
108.0 F in Rm 203 | 107.6 in Rm 206 | 111.8 F in Rm 207 | 109.4 F in Rm 303 | 105.4 in Rm 3034

LPA reviewed (10) client records, (10) Client Medication Administration Records, (8) Hospice Plan of Care Orders and (12) Personal & Incidental Records (P & I's)and did not observe any discrepancies at the time of visit.
First Aid kit was checked and is fully stocked.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies therefore no citations were issued at this time.



An exit interview was conducted, and a copy of the report was provided to David Hernandez (Assistant Administrator).
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2024
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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