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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602236
Report Date: 11/22/2021
Date Signed: 11/22/2021 02:17:06 PM

Document Has Been Signed on 11/22/2021 02:17 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:LADERA HOMES IFACILITY NUMBER:
198602236
ADMINISTRATOR:FAULKNER, RENEEFACILITY TYPE:
740
ADDRESS:6118 SOUTH LA BREA AVENUETELEPHONE:
(323) 447-2231
CITY:LOS ANGELESSTATE: CAZIP CODE:
90056
CAPACITY: 5CENSUS: DATE:
11/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:53 PM
MET WITH:Renee Faulkner TIME COMPLETED:
03:04 PM
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On 11/22/2021, Licensing Program Analyst (LPA) Ngozi Nwaokoro conducted an unannounced visit to Ladera Home I. The purpose of today’s visit was to conduct the annual inspection, with emphasis on Infection Control. LPA met with the Licensee, Renee Faulkner and explained the reason for the visit. Facility is licensed for 5 ambulatory residents. The facility also has an approved hospice waiver for 2 residents. The facility currently has 5 ambulatory residents. None of the residents are receiving home health or hospice services. All the residents were at the day program, at the time of this visit. The facility handles the money for three residents.

LPA Ngozi and Renee Faulkner toured the physical plant, checked food service, reviewed staff records and reviewed resident files for medical status. The facility conducted a fire drill on 09/09/2021. The home consists of 4 resident bedrooms, 1 of the 4 bedroom is a shared room,1.5 bathrooms, living room, dining room. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets were checked, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured at 112.6 degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked in the hallway closet.


Common areas were clean and clear of hazards; doorways were free of obstructions. All doors have auditory alarms.

Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. Cleaning solutions and hazardous items were placed in cabinets. Smoke detectors were working properly. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises.

No deficiencies cited during this visit.

Exit interview conducted and a copy of this report was given to Renee Faulkner.

SUPERVISORS NAME: Michael Cava
LICENSING EVALUATOR NAME: Ngozi Nwaokoro
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2021
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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