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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601665
Report Date: 11/07/2022
Date Signed: 11/07/2022 10:34:35 AM

Document Has Been Signed on 11/07/2022 10:34 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ELEGANT CARE INC.FACILITY NUMBER:
198601665
ADMINISTRATOR:JEWEL REESEFACILITY TYPE:
740
ADDRESS:834 E. 74TH ST.TELEPHONE:
(323) 821-1601
CITY:LOS ANGELESSTATE: CAZIP CODE:
90001
CAPACITY: 6CENSUS: 5DATE:
11/07/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:43 AM
MET WITH:Stacey Thomas - CaregiverTIME COMPLETED:
10:45 AM
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Licensing Program Analyst(s) (LPA) Mary Flores conducted a plan of correction (POC) visit to cleared deficiencies given during annual visit conducted on 10/27/22. LPA Flores met with Stacey Thomas Caregiver and explained the reason for the visit.

On 10/27/22 LPA Flores conducted an annual visit and the following deficiencies were noted during that visit:

Section CCR 87303(e)(2) Maintenance and Operation -. Water temperature was tested in bathroom #1(B1) at 124.5 degrees F. On 11/7/22 LPA Flores tested water temperature at 120.0 degrees F. Deficiency cleraed on 11/7/22.


Section CCR 87705(j) Care of Persons with Dementia -. exit doors were observed to not have auditory device. On 11/7/22 LPA Flores observed the auditory devices in each exit door. Deficiency cleared on 11/7/22.


Exit interview was conducted with Stacey Thomas Caregiver and a copy of this report was provided.
SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2022
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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