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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320466
Report Date: 06/18/2025
Date Signed: 06/18/2025 01:01:32 PM

Document Has Been Signed on 06/18/2025 01:01 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:BB CARES LOMITAFACILITY NUMBER:
198320466
ADMINISTRATOR/
DIRECTOR:		BANGASH FARAHFACILITY TYPE:
740
ADDRESS:2254 250TH STREETTELEPHONE:
(310) 955-8213
CITY:LOMITASTATE: CAZIP CODE:
90717
CAPACITY: 6CENSUS: 0DATE:
06/18/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Bangash FarahTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 06/18/2025 at around 10:00 AM Licensing Program Analyst (LPA) Antonine Richard conducted an announced visit to the facility for the purpose of a pre-licensing evaluation. LPA met with the Administrator Bangash Farah and staff Maria Bangash.

On 03/04/2024 an application was submitted to CCLD, for Initial license for a Residential Care Facility Elderly (RCFE) to serve resident ages 60 and above. The facility was approved for a capacity of 6 ambulatory residents, zero (0) non-ambulatory and zero (0) bedridden residents in this facility. The facility is a one-story house located on a residential street. The facility is composed of 3 bedrooms, 2 bathrooms, 1 kitchen/common room area, 1-dining room, 1 backyard, 1 detached garage and 1 storage room. LPA conducted a review of the Physical Plant, Bedrooms, Bathrooms, Supplies, Food Service, Medications, Records, Administration, Activities, Pe-Licensing Checklist and Component III Orientation.

PRE-LICENSING CHECKLIST

NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Antonine Richard
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: BB CARES LOMITA
FACILITY NUMBER: 198320466
VISIT DATE: 06/18/2025
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LPA observed ample supply of clean linen. There is 1 fully charged fire extinguisher located in the living room areas mounted on the wall. LPA observed a 7-day supply of nonperishable foods and 3-day supply of perishable foods, 1 fully stocked first aid kit with tweezers, scissors, band aid, gauze, antibiotic ointment and manual, all exits are marked, hallways and passageway are clean and clear of clutter and obstructions. The front and back yard areas are well maintained. No bodies of water nor firearms are on the property.

Bedrooms Residents: Bedrooms 1-3 have working lights, new blinds and working windows with no bars. All Bathrooms have a working toilet, wash basins and shower, and observed to be clean, safe, and sanitary. LPAs observed adequate lighting in throughout the entire facility. Linens & Hygiene Supplies: Extra linens are in hallway closet. Living room is fully furnished with sofa, 2 chairs, coffee table, and mounted TV. There is adequate space for activities. Smoke Detectors: Facility has 6 smoke detectors/carbon monoxide detectors are hardwired and interconnected. They were tested and operable. Water Temperature: Tested at 115.1 degrees F. Clients & Staff Files: will all be stored in locked area in the living room. Medications: There is a locked centralized storage area for resident medications.

LA City Fire Department clearance granted on 11/20/24 with approval for (6) ambulatory residents 60 and above.

COMPONENT III

NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Antonine Richard
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
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: BB CARES LOMITA
FACILITY NUMBER: 198320466
VISIT DATE: 06/18/2025
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COMPONENT III

Information was provided about how to operate the facility within substantial compliance.

There are no corrections needed.

An exit interview was conducted, and a hard copy of this report has been furnished to the applicant. Bangash Farah

Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to the applicant.

NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Antonine Richard
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC809 (FAS) - (06/04)
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