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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602216
Report Date: 06/27/2024
Date Signed: 06/27/2024 04:57:31 PM

Document Has Been Signed on 06/27/2024 04:57 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:FRANCESCA'S HOMEFACILITY NUMBER:
198602216
ADMINISTRATOR/
DIRECTOR:		COELLO, BESSIE LFACILITY TYPE:
740
ADDRESS:20520 AVIS AVENUETELEPHONE:
(310) 292-8425
CITY:TORRANCESTATE: CAZIP CODE:
90503
CAPACITY: 6CENSUS: 6DATE:
06/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Bessie CoelloTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 06/27/24, Licensing Program Analyst (LPA), Wendy Gibbs conducted an unannounced annual visit to the facility listed above. LPA met with Administrator, Bessie Coello, and the purpose of today’s visit was explained. The facility is licensed for 6 residents over the age of 60, five (5) non-ambulatory of which 1 may be bedridden. The facility has an approved hospice waiver for 2 residents.

File Review/Interviews LPA reviewed the files for the six (6) residents and observed they had the required documents. LPA interviewed three (3) residents, and both were happy with the care they receive at the facility. LPA reviewed the administrator and two (2) staff files and found they contained the required documents, certification, and training. The administrator’s Administrator Certificate is valid till 01/01/25.

Medication LPA observed all Centrally Stored Medications secured in a locked filing cabinet, in a locked staff room, and are inaccessible to residents. All medications were observed in their original packaging. LPA reviewed the medications and Medication Administration Record (MAR) for the six (6) residents. Six (6) out of six (6) resident’s MARs and medication are consistent with properly documented records.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2024
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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: FRANCESCA'S HOME
FACILITY NUMBER: 198602216
VISIT DATE: 06/27/2024
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Infection Control Upon entry, LPA observed a sanitizing station and visitor sign-in log. LPA observed on the table there is a thermometer, hand sanitizer and masks available. LPA observed all visitor temperature was taken and logged. LPA observed all required Infection Control signs posted in the facility.

Due to time constraints, LPA will return to complete the annual visit.

During today's visit, LPA did not observe or site any deficiencies.

An exit interview was conducted with Administrator, Bessie Coello, and a copy of this report was provided.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
LIC809 (FAS) - (06/04)
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