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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602390
Report Date: 10/31/2024
Date Signed: 10/31/2024 05:34:39 PM

Document Has Been Signed on 10/31/2024 05:34 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:DANIELLA'S HOMEFACILITY NUMBER:
198602390
ADMINISTRATOR/
DIRECTOR:		COELLO, BESSIE LFACILITY TYPE:
740
ADDRESS:18005 OSAGE AVENUETELEPHONE:
(310) 371-4088
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY: 6CENSUS: DATE:
10/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:23 PM
MET WITH:Bessie CoelloTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 10/31/24, the department conducted an unannounced annual visit using the full CAREs tool. The department met with Administrator, Bessie Coello, and the purpose of today’s visit was explained. The facility is licensed to serve six (6) non-ambulatory clients, one of which may be bedridden, and an approved hospice waiver for two (2). Currently there are four (4) clients residing in the facility.
Structure/Physical Plant The facility is a two-story home in a residential neighborhood. The home consists of 4 bedrooms, 2 ½ bathrooms, family room, living room, kitchen, dining room, indoor and outdoor activity area, laundry room, front yard, and backyard. There is a shaded area with table and chairs. The department observed a fenced pool on the premises. All walkways around the facility were observed to be clean, clear, and free of obstructions, hazards, and debris.
Bedrooms The department inspected all client rooms and found them to be clean and in good repair. All rooms have the required furniture including a bed, dresser, nightstand, chair, and storage space for personal belongings. The department observed all beds to have the required linens including a mattress cover, fitted sheets, blankets, comforter, and pillows. The department observed an ample supply of linens in resident rooms. All bedrooms have ample lighting.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2024
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: DANIELLA'S HOME
FACILITY NUMBER: 198602390
VISIT DATE: 10/31/2024
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Bathrooms The department inspected all bathrooms and found them to be within Title 22 regulations. All bathrooms were observed clean and operational. The department observed an adequate supply of towels and personal hygiene supplies. Secured handrails and non-skid mats were observed in both bathrooms.
Kitchen The department observed the kitchen to be clean and sanitary. All appliances were tested and found to be in good working repair. The department observed an ample supply of cutleries, cookware, and dishware in good repair. The department observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods properly stored, packaged, and labeled. A sample menu was posted on the refrigerator. All sharps were observed secured in a locked drawer in the kitchen and are inaccessible to client. All cleaning supplies were secured in a locked cabinet in the activity room and are inaccessible to clients.
Common Rooms In the living room, the department observed two couches and chairs for client use. In the family room, the department observed a couch available for clients. The department observed games and activities in the activity room. The dining room has a large table and chairs to accommodate all clients. The department observed all walkways and hallways to be clean, clear, and free of obstructions and hazards. All rooms were observed with ample lighting. The facility was maintained at a comfortable temperature.
Safety Smoke and Carbon Monoxide Detectors are in compliance and are operational. The department observed two fully charged fire extinguishers last serviced on 08/29/24. The last Fire Prevention Inspection was conducted on
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024
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: DANIELLA'S HOME
FACILITY NUMBER: 198602390
VISIT DATE: 10/31/2024
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07/24/2023. The last emergency drill was conducted on 07/10/24. The First Aid Kit was inspected and found to contain all required item and a manual. The facility has a working landline telephone. The department observed all required documents posted throughout the facility. There are no firearms stored on the premises.
Infection Control The department observe the facilities infection control procedures. The department observed a sanitizing station at the entrance of the facility. All required infection control signs were posted throughout the facility. The facility has a 30-day supply of PPEs.

During today's visit, the department did not observe or cite any deficiencies.

LPA will return to the facility to complete the annual.

An exit interview was conducted with Licensee, Bessie Coello, and a copy of this report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024
LIC809 (FAS) - (06/04)
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