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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320203
Report Date: 09/09/2021
Date Signed: 09/09/2021 03:13:30 PM

Document Has Been Signed on 09/09/2021 03:13 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:ADORABLE REDBEAM HOMEFACILITY NUMBER:
198320203
ADMINISTRATOR:LINAYAO, KADIGUIA O.FACILITY TYPE:
740
ADDRESS:22521 REDBEAM AVE.TELEPHONE:
(424) 777-8707
CITY:TORRANCESTATE: CAZIP CODE:
90505
CAPACITY: 6CENSUS: 4DATE:
09/09/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Kadiguia LinauaoTIME COMPLETED:
03:30 PM
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On 9/9/21 Licensing Program Analyst (LPA) Martessa Brown conducted an announced visit to the facility for the purpose of a pre-licensing evaluation. During today’s visit LPA met with Liyan and conduct a tour of the facility an application was submitted to CCLD on 08/16/2021, for a Residential Care Elderly Facility to serve residents 60 and over. 6 Non-Ambulatory and 1 may be bedridden.
The facility has 4 bedrooms, 3 bathrooms, kitchen, living room and dining area, attached two car garage with washer and dryer and 1 frigerated and small deep freezer which is for staff use. LPA observed outside area has a covered patio that contained 1 table, couch and 2 chairs. Outdoor passageways, walkways, driveways, steps and patios are free from obstructions. LPA did not observe hazards, such as ladders, gardening tools and/or motorized equipment in the front, back and/or side areas of the facility. Bedrooms Residents: All Bedrooms are for 6 non-ambulatory clients. Bedrooms #1-#4 each have beds, one table and chair, one lamp in addition to overhead lighting. There is one nightstand with drawers in each bedroom which comply with the requirement of 8 two drawers and permanent closet space. There were no designated staff bedrooms observed. Bathrooms: Have a working toilet, wash basins, and Bathrooms #1 has a shower/tub with 1 grab bar on the side of the wall. Bathrooms #2- #3 has a shower and tub with grab bars. LPA observed adequate lighting through he facility. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored in hall closet. LPA observed closet fully stocked with mask, gowns and hand sanitizer.
LIC-809 is on the next page
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Martessa Brown
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2021
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: ADORABLE REDBEAM HOME
FACILITY NUMBER: 198320203
VISIT DATE: 09/09/2021
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Emergency Phone Numbers, Exit Plan & Menu: The telephone system has a land line. Emergency Disaster Plan and "See something, Say something Let Us Know" posted & readily available for review on the wall between the living room and kitchen. Menu available for review located in a locked kitchen cabinet opposite the refrigerator. Fire Extinguisher mounted on the kitchen wall opposite postings.
Food Service: Dishes, cups and flat ware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are stored in a locked cabinet located in the kitchen area. Food supply; stored in kitchen refrigerator and cabinets and consists of the following: A variety of Fresh and Canned fruit, vegetable and meat food items. Smoke Detectors: 6 hard wired smoke detectors are battery and electric operated & working. Carbon monoxide detector located in the living room and mounted to the wall. Appliances: Stove burners, oven, microwave, washer, and dryer working. There are 2 refrigerators in the home, one in the kitchen and one in the garage for additional food storage. Refrigerator in the kitchen has a measured temperature of at least 47 degrees Fahrenheit for appropriate food storage. Freezer is at 0 zero degrees Fahrenheit. The residence is equipped with central air and heat and each client bedroom is individually climate controlled. Toxins: Locked/stored in the storage room located in the kitchen. Water Temperature: Tested in bathroom #1 107 F, #2 106 F and #3 106 F degrees. Medications, First-Aid Kit & Book: Medication administration records and first aid kit has been inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze and current first aid manual, which are stored in locked kitchen cabinet adjacent the refrigerator, available for staff use but inaccessible to residents. Clients & Staff Records of staff and clients shall be stored in a locked in staff office and the section has been inspected along with the available records present. Administrator will not be handling resident’s money.
LIC-809-C is on the next page
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Martessa Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
LIC809 (FAS) - (06/04)
Page: 2 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: ADORABLE REDBEAM HOME
FACILITY NUMBER: 198320203
VISIT DATE: 09/09/2021
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Reading Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the client's use. Pool/Jacuzzi & Pets: LPAs did not observe any pet or bodies of water at the facility. Fire clearance: Fire Clearance was approved on 6/18/21 for 6 non-ambulatory and 1 may be bedridden. LPA did not observe pad locks or other mechanisms which may be obstructions for safe and quick egress during an emergency on side.

Component III was conducted on the day of the pre-license 9/9/21. Facility, information provided about how to operate the facility within substantial compliance. LPA did not observe any deficiency during the inspection.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Martessa Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3