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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320066
Report Date: 04/03/2024
Date Signed: 04/03/2024 04:03:59 PM

Document Has Been Signed on 04/03/2024 04:03 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:MANHATTAN PLACE RESIDENCE INCFACILITY NUMBER:
198320066
ADMINISTRATOR:
ADMINISTRATOR/
DIRECTOR:
PHAN, PAULFACILITY TYPE:
740
ADDRESS:16303 MANHATTAN PLTELEPHONE:
(310) 819-8681
CITY:GARDENASTATE: CAZIP CODE:
90247
CAPACITY: 6CENSUS: 4DATE:
04/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
TIME VISIT/
INSPECTION BEGAN:
01:31 PM
MET WITH:Miriam Ventura, AdministratorTIME COMPLETED:
TIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 4/3/24 Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced visit to this facility. The purpose of today’s visit was to conduct an Annual Inspection. LPA met with Mariel Ventura, Administrator. Facility is licensed for (6) residents (3) non-ambulatory and (3) ambulatory residents.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: 4 bedrooms, 2 bathrooms, living room, kitchen, dining room/laundry area, covered front porch and back porches both with ramps, and an attach 2 car garage.



LPA Shirley and Mariel toured the physical plant. There are no bodies of water or firearms on the premises. All client rooms were checked. Beds and bedding were in good condition, adequate lighting provided, storage for client personal belongings was observed. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 109.2 F.

A comfortable temperature is maintained in the facility. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were inaccessible to clients. The kitchen was inspected and there is enough perishable and non-perishable food available which is stored properly. The fire extinguisher was charged, smoke detectors and carbon Monoxide were operable. LPA checked first aid kit; and found that it was compliant with a manual.

LPA also observed that the facility has a 30-day supply of Personal Protective Equipment (PPE). And all mandated posters were posted.

There were no deficiencies observed during today’s visit. Exit interview held and a copy of the report was provided to the Administrator, Mariel Ventura.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2024
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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