Facility Evaluation Report

On 3/16/2026 at approximately 10:00 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. LPA was greeted by the caregiver and stated the reason for their visit. LPA spoke with the Administrator, Clifton Von Buck who was not available and designated staff member, Faith Kemanzi to assist with today’s visit.

LPA asked for the census, Staff/Resident Roster, and liability Insurance. LPA conducted a physical plant tour at approximately 11:30 AM and the following was noted:

The facility is a single unit building with four (4) bedrooms and three (3) bathrooms currently occupying four (4) residents. There is a designated staff room with its own private bathroom. The facility has an approved fire clearance for four (4) ambulatory residents. The facility is vendor through North Los Angeles Regional Center (NLARC) and is being operated at a Level II Residential Home for the Elderly.

Common areas: The living room and dining room were observed to be neat, clean, and organized. Both rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 70°F. A fire extinguisher is located in the kitchen was observed to be fully charged. Required postings such as See/Say Something, Facility License, and Rights of Individuals with Developmental Disabilities were observed to be located throughout the common areas. A working telephone was observed.

Kitchen: The kitchen was observed to be clean and free from pests. Sufficient supplies of seven (7) day nonperishable food and two (2) day perishable foods were observed. The cleaning solutions/toxins and knives/sharps were observed to be kept locked underneath the kitchen sink. The kitchen appliances were observed to be working and in proper condition. (continued on LIC 809-C)