<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602216
Report Date: 06/28/2024
Date Signed: 06/28/2024 04:06:04 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/28/2024 04:06 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: 5DATE:
06/28/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:34 PM
MET WITH:Bessie CoelloTIME VISIT/
INSPECTION COMPLETED:
04:15 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 06/28/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted a subsequent visit to the facility above to continue an annual from 06/27/24. 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.
Physical Plant/Structure The facility is a single-story home located in a residential neighborhood. The home consists of the following: four (4) bedrooms, two (2) bathrooms, living room, dining area, kitchen, laundry/utility room, and attached garage. Outside, LPA observed a shaded patio with a table and chairs accessible for resident’s use. LPA observed all walkway around the home to be clean, clear, and free of obstruction, debris, and hazards. LPA did not observe any bodies of water on the premises.
Bedrooms LPA inspected all resident rooms and found them to be clean and in good repair. LPA observed the rooms have the required furniture including a bed, dresser, nightstand, chair, and storage space for personal belongings. LPA observed the beds have the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillows. LPA observed an additional supply of
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2024
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 3
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: 06/28/2024
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
26
27
28
29
30
31
32
linens stored in a closet in the hallway. All linens and mattress were observed in good condition. All rooms were observed to have ample lighting.
Bathrooms LPA observed all bathrooms to be operable and within Title 22 regulations. The toilet, facets, and shower work properly. The bathrooms were observed clean. The showers were observed with secured safety handrails, nonskid mats, and a shower chair. The showers were observed to be free of mold and mildew. LPA observed storage space for residents’ hygiene products. LPA observed an ample supply of towels and hygiene products available for residents. The water temperature measured 114.8-degrees Fahrenheit.
Kitchen LPA observed the kitchen to be clean and sanitary. LPA observed all appliances to be operable. LPA observed an ample supply of cookware, dishware, and cutleries. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods. All foods were observed properly labeled, dated, packaged, and stored. LPA observed knives and sharps to be secured in a cabinet in the laundry/utility room and are inaccessible to residents. LPA observed cleaning supplies to be secured in locked cabinet in the laundry/utility room and are inaccessible to residents. The water measured 107.7-degrees Fahrenheit.
Common Rooms LPA observed the living room to have a chair and two couches to accommodate all residents. LPA observed in the dining room a large table to accommodate all residents. LPA observed activities and reading material available for residents. All walkways and hallways in the home were observed to be clean, clear, and free of hazards and obstructions. The facility was kept at a comfortable temperature. All rooms and hallways were observed to have ample lighting.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 06/28/2024
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
26
27
28
29
30
31
32
Safety LPA observed the smoke detectors and carbon monoxide detector to be operable. LPA observed a fully charged fire extinguisher last serviced on 08/24/23, located at the kitchen. The last emergency drill was conducted on 06/01/24. The facility has a working landline telephone. LPA observed the facility’s Emergency and Disaster Plan and required postings posted in the hallway near the entrance. LPA reviewed the Liability Insurance (PHPK2621828) through Acord that is valid till 11/03/24.
During today’s visit, LPA did not observe or cite 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: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3