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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320370
Report Date: 05/08/2024
Date Signed: 05/08/2024 11:45:40 AM

Document Has Been Signed on 05/08/2024 11:45 AM - 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:OCEANVIEW ESTATEFACILITY NUMBER:
198320370
ADMINISTRATOR/
DIRECTOR:		DEMAFELIX, JEHN MARICFACILITY TYPE:
740
ADDRESS:30757 RUE VALOISTELEPHONE:
(310) 533-1131
CITY:RANCHO PALOS VERDESSTATE: CAZIP CODE:
90275
CAPACITY: 6CENSUS: 2DATE:
05/08/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:26 AM
MET WITH:JM Demafelix/AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 5/8/24, Licensing Program Analyst-LPA Alfonso Iniguez conducted an unannounced post-licensing visit and met with JM Demafelix/Administrator, and the purpose of the visit was explained. The facility is licensed to serve (6) elderly residents ages 60 and over. The fire clearance is approved for (2) ambulatory and (4) no-ambulatory, of which (4) may be bedridden. Bedridden in bedrooms #2, #3 and #5. Waiver/Granted for hospice care for (6). Currently, the facility has (2) residents. Per CAB, the following item(s) need to be reviewed during the post-licensing inspection:

· Personnel Policies

· Abuse Reporting Procedures

· In-Service Training and Medication Procedures

During the visit, LPA and Administrator collaborated closely, reviewing the policies and procedures the facility submitted to CAB on initial application of license. The facility also has current policies on file. A joint tour of the facility was conducted, ensuring a shared understanding of the operations.


According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies therefore no citations were issued at this time.

An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to JM Demafelix /Administrator.


SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2024
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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