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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198204848
Report Date: 02/06/2025
Date Signed: 02/06/2025 12:57:10 PM

Document Has Been Signed on 02/06/2025 12:57 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:PLD FAMILY HOME CAREFACILITY NUMBER:
198204848
ADMINISTRATOR/
DIRECTOR:		PRECIOUS DENNISFACILITY TYPE:
740
ADDRESS:139 WEST ELLIS AVENUETELEPHONE:
(310) 419-5829
CITY:INGLEWOODSTATE: CAZIP CODE:
90302
CAPACITY: 6CENSUS: 6DATE:
02/06/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:55 AM
MET WITH:Precious DennisTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On February 6, 2025, Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced Case Management Annual Continuation to complete inspection conducted on January 31, 2025 using the CARE Inspection Tool. LPA met with Precious Dennis and explained the purpose of this visit. The facility is licensed for (6) 60-year-old or older adults. May retain 1 hospice resident. Currently, there are 6 residents in the facility.

The facility is a single-story home located in a residential neighborhood which consists of the following: A living room, four (4) bedrooms, two (2) bathrooms, one (1) half-bathroom, dining room, kitchen, laundry area, detached garage, shaded area, indoor/outdoor activity areas.

Safety LPA observed and tested smoke/carbon monoxide combo detectors to be fully operable. LPA observed (2 ) fully charged fire extinguishers that was last serviced on 01/18/2025. The last emergency drill was conducted on 1/12/25. LPA inspected the First Aid kit and found it contained an ample supply of required items: Scissors, tweezers, gauze, disinfectant wipes, band aids. LPA observed all exits to be clear and easily accessible. All toxins locked and inaccessible to residents in care.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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: PLD FAMILY HOME CARE
FACILITY NUMBER: 198204848
VISIT DATE: 02/06/2025
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Medications LPA observed all centrally stored medications in their original packaging and are secured in a locked cabinet that is inaccessible to Residents in care.

Files LPA reviewed ( 4 ) resident files and found that (4) out of (4) contained all the necessary documentation. LPA reviewed (4) staff files and found that (4) out of (4) contained the required documentation, certification, and training. Liability Insurance expires on 06/24/25

Infection Control During the visit, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance. PPE supplies are readily available to staff.

Outside area: During visit LPA observed the outside grounds (front and back) to be free of clutter, debris, and passage ways were free of obstruction.

There were no deficiencies cited during today’s visit.

Exit interview conduct and copy of report provided to Administrator Precious Dennis.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC809 (FAS) - (06/04)
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