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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198204545
Report Date: 08/27/2022
Date Signed: 08/30/2022 10:19:20 AM

Document Has Been Signed on 08/30/2022 10:19 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:SIMLA VILLAS, REDONDO BEACHFACILITY NUMBER:
198204545
ADMINISTRATOR:SIMLA MEHTAFACILITY TYPE:
740
ADDRESS:2805 ROBINSON STREETTELEPHONE:
(310) 483-6965
CITY:REDONDO BEACHSTATE: CAZIP CODE:
90278
CAPACITY: 6CENSUS: 5DATE:
08/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Mehta Simla, AdministratorTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual required and infection control visit to the above facility. LPA was met by Lyn bacos and later met with Simla Mehta, Administrator and the purpose of today’s visit was explained.

There are currently (5) residents in the facility. (1) resident is ambulatory, (3) are non-ambulatory, (1) bedridden. The facility is a two story structure located in a residential neighborhood. It has a ramp going along side front of home. The 1st floor is the facility and 2nd floor is for staff. 1 st floor It consists (7) bedrooms, (3) full bathrooms, 1/2 bathroom is in room #7. Sun room, book/activities area, living room/office area, dining room, kitchen/office area, ramp along side of living room & dining room also ramp along side of hallway to bedrooms, shaded back yard, front yard, gazebo, laundry room is part of bathroom #1 and an attached 2 car garage.

LPA and Lyn toured the entire facility inside and out. Documents are posted as mandated. Bedrooms 1 is vacant, Bedroom 2-6 are occupied by residents and contain the mandated furniture. Bedroom 7 is a staff bedroom. The (3) bathrooms are clean and operational. (1/2) bathroom is in staff bedroom #7. First aid kit is fully stocked with manual; smoke detectors and carbon monoxide detector were in compliance and operational. Facility had the smoke detectors and fire alarm system checked March 2022 and provided documents. The system is inter-connected and its connected with the Fire Department. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. (1) Resident file along with medications are current. (1) Staff file is current. Ample supply of perishable and nonperishable food, hot water temperature is between 105 -120 degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, (3) fire extinguisher are fully charged. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE: DATE: 08/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/27/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SIMLA VILLAS, REDONDO BEACH
FACILITY NUMBER: 198204545
VISIT DATE: 08/27/2022
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 During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry & visitors and temperatures are logged and checked. Sanitizer/soap, paper towels, in all the bathrooms and additional sanitation supplies are stored in the garage. LPA observed staff wearing masks, resident private rooms will be converted to isolation rooms (if needed.) trash cans with lids, No cart for PPE’s, mitigation plan posted and/or in folder, No fit testing completed for staff, and required postings throughout the facility. Visitation designated area, facility has internet for residents use, resident’s temperatures are checked and logged (once a day). Emergency contacts updated and posted; PPE's are enough for 30 days.

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

Technical Advisory(TA) was issued:

1. No fit testing completed for staff.

An exit interview conducted with Mehta Simla, Administrator and a hard copy of report provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2022
LIC809 (FAS) - (06/04)
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