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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602924
Report Date: 11/22/2024
Date Signed: 11/22/2024 01:04:48 PM

Document Has Been Signed on 11/22/2024 01:04 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:RICH RESIDENTIAL CARE LLC 2FACILITY NUMBER:
198602924
ADMINISTRATOR/
DIRECTOR:		RICHARDSON, GENTRYFACILITY TYPE:
740
ADDRESS:2030 W. 94TH PLACETELEPHONE:
(310) 350-1123
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY: 4CENSUS: 4DATE:
11/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:09 AM
MET WITH:Richard GentryTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
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On 11/22/2024, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced annual required visit using the new Care Tool. LPA Richard met with the Administrator Gentry Richardson and LPA Richard explained the purpose of today’s visit. The facility is licensed to operate four (4) ambulatory Seniors ages 60 and above. Currently, four clients reside at this facility.

The facility is a one-story structure located in a residential neighborhood. It consists of the following: three (3) bedrooms (three client bedrooms), one (1) staff office room (non-staff bedroom), two (2) bathrooms, living area, dining area, kitchen, outside area with table, umbrella, and chairs. LPA Richard toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for client personal belongings was observed. Bathrooms were found to be clean and operational. The water temperature measured above Title 22 regulations at 107.4F. Storage areas for personal hygiene, toxins, and sharp objects were stored and not accessible to clients. Bleach and cleaning solution was located under the sink in bathroom two (2). A fire/emergency drill was conducted on 08/11/2024.

See LIC809-C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024
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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: RICH RESIDENTIAL CARE LLC 2
FACILITY NUMBER: 198602924
VISIT DATE: 11/22/2024
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See LIC9099-C

The kitchen was inspected and there is sufficient perishable and non-perishable food available and maintained properly. Two fire extinguishers were charged, smoke detectors and carbon monoxide detectors were operable. During the visit, LPA Richard observed the facility has a Mitigation Plan Report approved by CCLD on file.

Exit interview conducted. A copy of the report was provided to the Licensee Gentry Richardson.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2024
LIC809 (FAS) - (06/04)
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