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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320164
Report Date: 12/13/2022
Date Signed: 12/13/2022 12:06:33 PM

Document Has Been Signed on 12/13/2022 12:06 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:PAPA JOE'S HANDSFACILITY NUMBER:
198320164
ADMINISTRATOR:SWAFFORD, RASHIMERFACILITY TYPE:
740
ADDRESS:216 E. 137TH. ST.TELEPHONE:
(310) 562-7694
CITY:LOS ANGELESSTATE: CAZIP CODE:
90061
CAPACITY: 4CENSUS: 0DATE:
12/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Rashimer SwaffordTIME COMPLETED:
12:20 PM
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On 12/13/2022 at 11:30am, Licensing Program Analyst (LPA) Perry Scott conducted an annual required visit, with a primary focus on infection control measures. LPA was met by Rashimer Swafford and the purpose of today’s visit was explained. The facility is licensed to serve four (4) ambulatory residents ages 60 and over; with a hospice waiver for three (3) residents. The facilities annual fees are current. Facility did not have any residents at the time of the visit.

As part of the inspection, my primary focus was on infection control. LPA observed the facility’s infection control practices: LPA observed a sanitizing station at the facility entrance. PPE supplies are readily available to staff and residents, and additional supplies are stored. Sufficient paper, cleaning, and disinfecting supplies were observed. The facility has the mandated COVID infection control posters.

LPA Scott and Rashimer Swafford toured the facility. The home consists of four (4) bedrooms, three (3) bathrooms, living Room, kitchen, dining area, garage, gas fireplace, and back yard. The water temperature measured at 115.5 f degrees. All rooms were checked, and mattresses and bedsprings are in good repair, adequate lighting, nightstand, chair, and closet space observed. Sufficient toiletries, linens towels and bedding for clients. First Aid kit was fully stocked with manual. Fire extinguisher was charged, smoke/carbon monoxide detectors were operable.

Continued on LIC809-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2022
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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: PAPA JOE'S HANDS
FACILITY NUMBER: 198320164
VISIT DATE: 12/13/2022
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Perishable and non-perishables food supply was adequate at time of visit. Outside grounds were toured. Backyard was free of debris, exit-ways and pathways were clear of hazards. All disinfectants, toxins, knives, and cleaning solutions were locked and inaccessible to clients. No bodies of water were observed.

During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff and residents, sanitizing stations (Located in common areas and restrooms). LPA observed staff was wearing face coverings, and the required postings were posted throughout the facility. LPA observed the facility has a 90-day supply of Personal Protective Equipment (PPE).



LPA advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing (www.cdss.ca.gov) for Provider Informational Notices (PIN) and for any updates relating to COVID-19 guidance.

During today’s visit there were no deficiencies cited.

Exit interview was conducted and a copy of the facility evaluation report was given to Rashimer Swafford.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
LIC809 (FAS) - (06/04)
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