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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601828
Report Date: 05/30/2024
Date Signed: 05/31/2024 03:45:47 PM

Document Has Been Signed on 05/31/2024 03:45 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:BUCKINGHAM PLACEFACILITY NUMBER:
198601828
ADMINISTRATOR/
DIRECTOR:		NAQUITA MEADOWSFACILITY TYPE:
740
ADDRESS:4108 W. 59TH PLACETELEPHONE:
(213) 361-2792
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY: 6CENSUS: 3DATE:
05/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Jaylin Abram-DSPTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 05/30/2024, Licensing Program Analyst (LPA) Troy Watson conducted an unannounced annual required visit. LPA met with Jaylin Abram and the purpose of today’s visit was explained. The facility is licensed to operate for (6) Developmentally Disabled adults ages 60 and up. Currently, the home has (3) clients.

The facility is a one-story home located in a residential neighborhood. The property consists of the following: 2 client bedrooms, 2 bathrooms, living room, kitchen, dining room, detached garage, and an outdoor patio area inaccessible to clients.

The LPA toured the inside and outside of the facility. All client rooms were checked. Mattresses and box springs were in good condition, adequate lighting was observed, plenty of dresser and closet space was observed. Walls and floors were clean and in good repair. Bed linens, comforters and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations. Toilets and water faucets worked properly. Shower was free of mold/mildew.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE: DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2024
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 2
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: BUCKINGHAM PLACE
FACILITY NUMBER: 198601828
VISIT DATE: 05/30/2024
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There is adequate lighting and sufficient toiletries accessible to clients. The water temperature measured between 115.1 F – 116.7 F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions.

Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available and stocked with scissors, tweezers gauze, and required manual in addition to alcohol wipes etc . No bodies of water were observed on premises. Walkways around the home were clear of hazards. There are no weapons on the premises and security bars in the rooms have safety latches for exit in case of a fire. This annual visit was completed on 05/31/24.

No Deficiencies were cited:

An exit interview was conducted and a copy of this report was provided.

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

DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024
LIC809 (FAS) - (06/04)
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