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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320378
Report Date: 03/19/2025
Date Signed: 03/19/2025 02:22:50 PM

Document Has Been Signed on 03/19/2025 02:22 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:SAVANT OF SANTA MONICAFACILITY NUMBER:
198320378
ADMINISTRATOR/
DIRECTOR:		NARINE MERTKHANYANFACILITY TYPE:
740
ADDRESS:1447 17TH STREETTELEPHONE:
(310) 829-5904
CITY:SANTA MONICASTATE: CAZIP CODE:
90404
CAPACITY: 174CENSUS: 91DATE:
03/19/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Nathaniel Venzon- AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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At 8:50 AM, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to conduct an annual inspection. LPA Allen was greeted by Francisco Orozco-Maintenance Director upon arrival. LPA introduced herself and explained the purpose of the visit,to Francisco Orozco who granted access into the facility. At 9:00 AM, Nathaniel Venzon- Administrator arrived and he was informed of the purpose of the visit.

The facility is licensed to serve at the capacity of (174) age range 60 and over adults. The fire clearance is approved for (150) non-ambulatory, (24) bedridden residents and hospice waiver for 30.

At 9:25 AM LPA reviewed ten (10) clients files for admission agreements, updated physician reports, and needs and services plans which were up to date.



At 10:15 AM, LPA and Francisco Orozco toured the physical plant. There were no bodies of water or obstructions in the indoor and outdoor passageways, stairways, open areas, and other areas of potential hazard are free of obstructions. LPA also observed the common areas to have furniture that appeared to be in good repair and sufficient for clients and visitors. The facility also has a shaded patio area for smoking and non-smoking with seating that can accommodate clients and visitors. The fire extinguishers were fully charged, and the last fire drill was conducted on 2/28/2025. LPA toured five (5) bedrooms downstairs and five (5) bedrooms upstairs which all have the required furniture,storage areas, and the bathrooms appeared to be clean and operational. LPA and Francisco tested the water temperature in the ten (10) bedrooms which ranged from 105-115 degrees F.

At 11:45 AM, LPA, conducted a tour of the kitchen and there was a menu available for review and there appeared to be enough perishable and non-perishable food available, which is stored properly and appeared to be sufficient for the number of clients in care.

At 12:43 PM, LPA reviewed ten (10) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings which were all current.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: SAVANT OF SANTA MONICA
FACILITY NUMBER: 198320378
VISIT DATE: 03/19/2025
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At 1:21 PM, LPA conducted a random audit for 6 (six) clients medications that appeared to be dispensed as prescribed by their physician and they were centrally stored and properly locked. The first aid kits and manual were checked and fully stocked.

LPA observed that all window screens were clean and in good repair. Facility temperature is between 68° degrees and 85° degrees. Overall, the facility appeared to be clean, sanitary, and in good repair.

Based on the observations made during today’s visit, no deficiencies were cited.

An exit interview was conducted, and this report was discussed and provided to Nathaniel Venzon- Administrator at the conclusion of the visit.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC809 (FAS) - (06/04)
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