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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320218
Report Date: 10/03/2024
Date Signed: 10/03/2024 04:09:13 PM

Document Has Been Signed on 10/03/2024 04:09 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:GRANDVIEW GUEST HOMEFACILITY NUMBER:
198320218
ADMINISTRATOR/
DIRECTOR:		SANTOS, JENNICE-RAE RUTAFACILITY TYPE:
740
ADDRESS:2444 235TH STTELEPHONE:
(310) 782-5045
CITY:TORRANCESTATE: CAZIP CODE:
90501
CAPACITY: 6CENSUS: 4DATE:
10/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:23 PM
MET WITH:President Coty CabralTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
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On 10/03/24, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with President Coty Cabral.

The facility is licensed to serve six (6) elderly residents, all of which (6) may be non-ambulatory with a hospice waiver approved for four (4) aged 60+ years. The facility consists of one floor level with: four resident rooms (Room 2 is designated for bedridden), two restrooms, kitchen, dining room, living room, and garage. The facility is clean, sanitary, and in good repair.



The President accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards.

Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. 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. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked.

Common areas were clean and clear of hazards. Doorways were free of obstructions.
Continue to LIC809-C.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: GRANDVIEW GUEST HOME
FACILITY NUMBER: 198320218
VISIT DATE: 10/03/2024
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LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were kept in locked storage cabinet. First Aid kit was available. Two fire extinguishers, last serviced on July 8, 2024 was observed in the living room and in the kitchen. Staff tested the carbon monoxide and smoke detectors in the house. Both devices were functional.

Five staff records were reviewed, and five out of five staff records had the required criminal record clearances or criminal record exemptions.

Four resident records were reviewed, and four out of four resident records had medical assessments and pre-appraisal or reappraisals. Two residents’ medication was reviewed.

No deficiencies are being cited.

An exit interview was conducted, technical assistance provided, and a copy of this report was discussed and left with President Coty Cabral.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC809 (FAS) - (06/04)
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