198320500-1-6-2025-11-AS-EGOZ-DCNSBF-20250106124349

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320500
Report Date: 01/06/2025
Date Signed: 01/06/2025 12:44:54 PM

Document Has Been Signed on 01/06/2025 12:44 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:	ADAY LLC		FACILITY NUMBER:	198320500
ADMINISTRATOR/ DIRECTOR:	KASSA, ABERA		FACILITY TYPE:	740
ADDRESS:	1801 W 43RD ST		TELEPHONE:	(971) 381-9188
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90062
CAPACITY: 6		CENSUS: 0	DATE:	01/06/2025
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:48 AM
MET WITH:	Abera Kassa		TIME VISIT/ INSPECTION COMPLETED:	12:30 PM

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On 01/06/2025, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an announced pre-licensing visit to this home. LPA was greeted by applicant Abera Kassa and explained the purpose of today’s visit. LPA was given access to the facility.

An application was submitted to CCLD on 06/03/2024 for an initial license application for a Residential Facility for the Elderly, ages 60 years and above. The applicant requested a capacity of six (6) non-ambulatory residents.

Structure:
The home is a seven (7) bedroom, three (5) bathroom, one story home with detached garage situated in a residential neighborhood. The home includes a living/dining room, kitchen, and laundry area. The living area included sectional seating. The kitchen has a refrigerator and stove. Passageways, walkways, and steps inside and out are free from obstructions.

Bedrooms Residents:
The facility has six (6) bedrooms for residents. All resident bedrooms include a bed, chair, and a nightstand. All bedrooms are equipped with ceiling lights and dressers, which comply with the requirement of 8 cubic feet of space. All rooms had closets for ample storage.

Bedrooms Staff:

One bedroom is designated for Administrator.

Bathrooms:

The home has five (5) bathrooms, one of which is in the Administrator bedroom. All bathrooms have a working toilet, washbasin, and shower with grab bars and non-skid mats.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025

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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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: ADAY LLC	FACILITY NUMBER: 198320500
	VISIT DATE: 01/06/2025

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Linens & Hygiene Supplies:
Beds have the required linen supplies which include, pillowcases, mattress pads, fitted sheets, blankets, and bedspreads. An adequate supply of linen is stored in the garage.

Emergency Phone Numbers, Exit Plan & Menu:
Emergency phone numbers. The exit plan and menu are posted and readily available for review throughout the home. There is one (1) fire extinguisher located in the kitchen mounted on the wall. Facility has a working telephone which was called by LPA and found to be operational. Emergency supplies and Personal Protective Equipment supplies are stored in the garage. The applicant has an approved Infection Control Plan on file.

Food Service:
Dishes, cups, and flatware are stored in the kitchen cabinets, inspected, and in good repair. Knives, cutlery, and other sharp kitchen utensils are stored in a locked kitchen drawer. Food supply is adequately stored and consist of (2) day supply of perishables and a (7) day supply of non-perishables. The kitchen counters also had small appliances.

Smoke Detectors:
Smoke and carbon monoxide detectors throughout the interior space. Hardwired smoke detectors/carbon monoxide in all bedrooms and hallways.

Toxins:
All toxins are locked and stored in a locked space under kitchen sink.

Appliances:
Kitchen appliances found to be within title 22 requirements. Home is equipped with central heaters and air conditioning systems.

Water Temperature:
The water temperature was found to be withing title 22 regulations throughout the kitchen and bathrooms.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025

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: ADAY LLC	FACILITY NUMBER: 198320500
	VISIT DATE: 01/06/2025

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Medications, First-Aid Kit & Book:
A first aid kit is stored in a cabinet in the kitchen, and contained thermometer, tweezers, scissors, antiseptic, bandages, gauze, and a current first aid manual locked and inaccessible to residents. The resident's medications will be stored in a cabinet locked in the kitchen area and inaccessible to residents.

Resident & Staff Files:
Records of staff and residents will be stored in the office area located in the Administrator bedroom.

Reading Material, Games, Equipment & Materials:
The facility has board games, books, magazines, and other recreational materials for the resident's use all stored in the living room.

Pool/Jacuzzi & Pets:
There are no pets, jacuzzi, or pool on premises.

A Fire Clearance inspection was conducted on 09/17/2024 and approved for a capacity for six (6) non-ambulatory and zero (0) bedridden residents ages 60 and over.

LPA Gonzalez noted the following correction needs to be made:

· Resident bedrooms shall be provided with a minimum of eight (8) cubic feet (.743 cubic meters) of drawer space per resident.

An exit interview was conducted, and a copy of this report was provided to Abera Kassa, facility Administrator.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025

LIC809 (FAS) - (06/04)

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