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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320410
Report Date: 05/24/2024
Date Signed: 05/24/2024 12:39:01 PM

Document Has Been Signed on 05/24/2024 12:39 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:GELILA RESIDENTIAL CARE FACILITYFACILITY NUMBER:
198320410
ADMINISTRATOR/
DIRECTOR:		YOHANNES, CHRISTIANFACILITY TYPE:
740
ADDRESS:3521 7TH AVETELEPHONE:
(310) 877-9395
CITY:LOS ANGELESSTATE: CAZIP CODE:
90018
CAPACITY: 6CENSUS: 0DATE:
05/24/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Christian YohannesTIME VISIT/
INSPECTION COMPLETED:
12:38 PM
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On 05/24/2024 Licensing Program Analysts (LPA) Troy Watson conducted a pre-licensing evaluation for Gelilal Residential Care Facility. Today’s pre-licensing evaluation was conducted with the Administrator Christian Yohannes.

The licensee has applied for a license to serve (6) ambulatory adults and (6) non-ambulatory residents. The fire clearance is approved for (6) ambulatory and (6) non-ambulatory residents. The building is equipped with (7) smoke/carbon monoxide detectors and 2 fully charged fire extinguishers with two exits for the residents.

A tour of the Kitchen, (2) Dining Room, (2) Living Rooms, (4) bedrooms, (2) bathrooms, shaded patio area, (1) Office, (1) Shed, (1) Storage area and perimeter of the facility for the clients was inspected by the LPA. Inspection of the inside and outside perimeters were conducted with the Administrator Christian Yohannes. Storage for all PPE are in a supply room which is located outside in the back of the main facility. Food, extra bedding, and linen was inspected and adequately furnished for the residents. A back yard with chairs and a shaded patio area was also observed. The front and back entrance of the facility has Exit signs and wheel chair ramps accessible to residents.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2024
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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: GELILA RESIDENTIAL CARE FACILITY
FACILITY NUMBER: 198320410
VISIT DATE: 05/24/2024
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SUPPLIES

There are clients’ personal hygiene supplies to include soap, toothpaste, toilet paper, and comb. There is a sufficient supply of clean linens to permit weekly changing of clients’ top sheets, bottom sheets, bedspreads, blankets, pillowcases, mattress covers, bath towels, hand towels, and washcloths.

FOOD SERVICE

Dining room is near kitchen. The facility currently has one refrigerator fully stocked with food. Freezer is 0° Fahrenheit. Refrigerator is a maximum of 45° Fahrenheit. A pantry located inside the kitchen has a (7) day supply of non-perishable food present. There are enough tableware, tables, dishes, and utensils. There is enough equipment for the storage, preparation, and service of food. All equipment, dishes, and utensils are clean and well maintained, kitchen, food storage, and preparation areas are clean.

RECORDS

There is a confidential storage space designated for client and personnel records at the facility.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: GELILA RESIDENTIAL CARE FACILITY
FACILITY NUMBER: 198320410
VISIT DATE: 05/24/2024
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The following was observed during this visit:

MEDICATIONS

There is a locked centralized storage area for clients’ medications inside the administrator’s office.

PHYSICAL PLANT

Facility is clean, sanitary, and in good repair. Protective devices are in place. Indoor and outdoor passageways, stairways, an open porch, and other areas of potential hazard are free of obstructions. All window screens are clean and in good repair. Facility temperature is between 68°F. degrees and 73°F. degrees. Open porches, and areas of potential hazard are well-lit. All (7) Smoke alarms were tested and operate properly. Carbon monoxide detectors operate properly.

BEDROOMS

All bedrooms have lamps, chairs, and sufficient lighting, mattresses, and pillows. There are 4 bedrooms in the main facility with dresser drawers and adequate closet space. Each room has night stands. And there is sufficient lighting in the hallway.

BATHROOMS

There are (2) bathrooms with accessible to the residents. There are (2) showers and (1) bathtubs. The hot water temperature in bathrooms and kitchen is between 112° Fahrenheit and 119.5° Fahrenheit. The bathrooms are located next to the bedrooms in the hallway.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: GELILA RESIDENTIAL CARE FACILITY
FACILITY NUMBER: 198320410
VISIT DATE: 05/24/2024
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ADMINISTRATION

The emergency exiting plan and emergency phone numbers are posted. Client Personal Rights are posted. Posting both sides of the Personal Rights form LIC 613 meets this requirement. Facility Visiting Policy is posted. A Licensing Complaint Poster See Something, Say Something is posted. There is space available for resident council meetings and resident council postings.

ACTIVITIES

There is an outdoor activity space with a table and chairs furnished for outdoor use. There is at least one common room available to clients for visitors.

A Component III PowerPoint presentation, and exit interview was conducted with the Administrator Christian Yohannes. A copy of this report was provided.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
LIC809 (FAS) - (06/04)
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