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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603667
Report Date: 05/01/2023
Date Signed: 05/01/2023 02:08:34 PM

Document Has Been Signed on 05/01/2023 02:08 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:YOU ARE WHY LLCFACILITY NUMBER:
198603667
ADMINISTRATOR:PALAFOX, LORANAFACILITY TYPE:
740
ADDRESS:12535 ELVINS STTELEPHONE:
(562) 724-0110
CITY:LAKEWOODSTATE: CAZIP CODE:
90715
CAPACITY: 6CENSUS: 0DATE:
05/01/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:DeAngela Santos - LicenseeTIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Luis Mora conducted an announced pre-licensing visit. LPA met with DeAngela Santos (Licensee), Paulo Santos (Licensee), and Lorena Palafox (Administrator) and explained the reason for the visit. An application was submitted to Community Care Licensing Department (CCLD) for a Residential Care Facility for the Elderly (RCFE) to serve 6 non-ambulatory residents in the age range of 60 and over.

A tour of the single-story facility included the 3 resident bedrooms (2 residents per room), 1 staff office, 2 bathrooms, living room, kitchen, dining area, attached garage, front yard and back yard. LPA Mora conducted the tour with DeAngela, Paulo, and Lorena, and observed the following: sufficient food supplies for at least 2 days of perishables and 7 days of non-perishables were observed in the kitchen. Kitchen appliances are clean and were operating at the time of the visit. Sharps were observed locked in a kitchen cabinet. Chemical and cleaning solutions are kept locked in the garage. The First Aid kit is kept in the kitchen and it is fully stocked with all required items including a current manual. Clean towels and extra clean linen were observed in the hallway closet. Dining and living room have sufficient lighting and sitting area. Medications will be kept locked in a kitchen cabinet. All bedrooms have all required furniture, lighting, and bedding. The bathrooms are clean and have the required grab bars in the shower and near the toilet for non-ambulatory residents. The showers have non-skid materials. Auditory devices were seen on all exit doors which are required for dementia residents and were operating at the time of the visit. The water temperature was tested in both bathrooms and measured at 114.2 degrees F and 115.1 degrees F, which is within the required 105-120 degrees F. A fire extinguisher was observed in the kitchen and are fully charged. Smoke detectors were observed throughout the facility and were operable during the visit. A carbon monoxide was observed in the hallway and was operable during the visit. The front yard and backyard are clean. There is a shaded area with seating in the backyard. No pools or bodies of water were observed at the facility. Passageways and exits are free of obstruction. Resident and staff files are kept locked in a living room cabinet.
(Continued to LIC 809C)
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Luis Mora
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2023
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: YOU ARE WHY LLC
FACILITY NUMBER: 198603667
VISIT DATE: 05/01/2023
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No outstanding or pending items were observed by the LPA requiring additional pre-licensing visits. LPA will notify the assigned Centralized Applications Bureau (CAB) Analyst of the completed pre-licensing facility evaluation visit conducted, which included the Component III Orientation.

Exit interview conducted and a copy of this report was provided.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Luis Mora
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023
LIC809 (FAS) - (06/04)
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