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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198204545
Report Date: 10/09/2024
Date Signed: 10/09/2024 02:50:22 PM

Document Has Been Signed on 10/09/2024 02:50 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:SIMLA VILLAS, REDONDO BEACHFACILITY NUMBER:
198204545
ADMINISTRATOR/
DIRECTOR:
SIMLA MEHTAFACILITY TYPE:
740
ADDRESS:2805 ROBINSON STREETTELEPHONE:
(310) 483-6965
CITY:REDONDO BEACHSTATE: CAZIP CODE:
90278
CAPACITY: 6CENSUS: 5DATE:
10/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:25 PM
MET WITH:Jennifer BobadillaTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one-year inspection. LPA met with Jennifer Bobadilla, Administrator ,and the purpose of the visit was discussed. The Facility is licensed to serve 6 non- ambulatory residents ages 60 and above. Currently there are 5 residents in placement. One (1) resident is receiving hospice services, Two (2) residents have dementia. The facility does not handle any of the residents’ money.

This home is a two story home. The 1st floor is where the residents reside and consists of the following: (6) resident bedrooms, (3) Full bathroom, (1) staff room and (1) staff restroom, den, living room, kitchen , dining room, laundry room , attached garage and an outdoor shaded patio and gazebo area. LPA toured the Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured between 112F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions.

Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises.

During todays visit LPA did not observe any deficiencies.

Exit interview conducted with Jennifer Bobadilla, Administrator

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Sparkle Day
LICENSING EVALUATOR SIGNATURE: DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2024
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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