198320511-1-23-2025-11-AS-SLEO-DD7TPV-20250123135458

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320511
Report Date: 01/23/2025
Date Signed: 01/23/2025 01:55:10 PM

Document Has Been Signed on 01/23/2025 01:55 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	A HELPING HAND SOUTH BAY		FACILITY NUMBER:	198320511
ADMINISTRATOR/ DIRECTOR:	ZOUGHI, SOHAYL		FACILITY TYPE:	740
ADDRESS:	4848 134TH PL		TELEPHONE:	(310) 973-1315
CITY:	HAWTHORNE	STATE: CA	ZIP CODE:	90250
CAPACITY: 6		CENSUS: 6	DATE:	01/23/2025
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Licensee / Administrator - Sohayl Zoughi		TIME VISIT/ INSPECTION COMPLETED:	02:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 1/23/2025, the California Department of Social Services (CDSS) – Community Care Licensing Division (CCLD) staff conducted an announced visit to the facility for purpose of a pre-licensing evaluation. On 04/29/2024, an application was submitted to CCLD, for Initial license for a Residential Care Facility for the Elderly to serve adults ages 60 and over. The requested capacity is for 6 non-ambulatory residents. PHYSICAL PLANT LAYOUT The facility is a one-story house located in a residential street. The home consists of 5 resident bedrooms (room 4 has a toilet, room 5 has a full bathroom), 1 staff room, 2 full bathrooms, 1 entrance room (has a fireplace with screen and fireplace gas is turned off), 1 great room area consisting of a kitchen, dining area, and a living room, and a backyard patio area with shaded seating. There is a detached garage. The facility only has access to the laundry room. The garage and the studio room is not part of the of the facility layout (licensee does not have access to the garage or studio room only property owner).

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025

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 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: A HELPING HAND SOUTH BAY	FACILITY NUMBER: 198320511
	VISIT DATE: 01/23/2025

NARRATIVE

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MEDICATIONS
There is a locked centralized storage area for resident medications.

PHYSICAL PLANT
Facility is clean, sanitary, and in good repair. Protective devices are in place to include non-slip material on rugs. Indoor and outdoor passageways, stairways, inclines, ramps, open porches, and other areas of potential hazard are free of obstructions. All window screens are clean and in good repair. Facility temperature is between 68 degrees and 85 degrees. Stairways, inclines, ramps, open porches, and areas of potential hazard are well-lit and equipped with sturdy hand railings.. Fire Alarms and Smoke alarms operate properly. Carbon monoxide detectors operate properly.

FOOD SERVICE
Dining room is near kitchen. Refrigerator(s) and freezer(s) are clean and large enough for the storage of at least two (2) days of perishable foods. Freezer is 0 degrees Fahrenheit. Refrigerator is a maximum of 45 degrees Fahrenheit. A seven (7) day supply of non-perishable food is present. There are sufficient amounts of tableware, tables, dishes, and utensils. There are sufficient amounts of equipment for the storage, preparation, and service of food. All equipment, dishes, and utensils are clean and well maintained. All kitchen, food storage, and preparation areas are clean.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025

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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: A HELPING HAND SOUTH BAY	FACILITY NUMBER: 198320511
	VISIT DATE: 01/23/2025

NARRATIVE

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RECORDS
There is confidential storage of personnel records at the facility. There is confidential storage of resident records at the facility.

POSTINGS
Mandated postings are posted.

ACTIVITIES
There is an Activity Coordinator who comes to the facility once a week for an hour. There is an outdoor activity space with a shaded area and furnished for outdoor use. There is at least one common room available to residents for visitors.

MISCELLANEOUS
There are first-aid supplies to include sterile first-aid dressings, bandages, adhesive tapes, scissors, tweezers, thermometer, antiseptic solution, and a current first-aid manual. There is space and equipment for laundry. There is a space for clean linen storage and a separate space for soiled linen. For facilities of 16 or more capacity, there is a designated laundry space. There are two operating telephones and a videoconferencing device available to residents. Emergency equipment available to residents.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025

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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: A HELPING HAND SOUTH BAY	FACILITY NUMBER: 198320511
	VISIT DATE: 01/23/2025

NARRATIVE

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COMPONENT III
Component III presentation was completed.

No plans of correction were provided.

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.

An exit interview was conducted, and a hard copy of this report was left with the Licensee/Administrator.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025

LIC809 (FAS) - (06/04)

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