Halldale Guesthome

Type of visit: Prelicensing

On 10/27/2025 around 1pm Licensing Program Analysts (LPA) Jose Calderon conducted an announced visit to Halldale Guest Home Facility located at 23438 Halldale Ave Harbor City CA 90710 and met with Licensee/Administrator Evangeline Agatep for purpose of a pre-licensing evaluation. The facility is licensed to operate six (6) non-ambulatory elderly adults of which two (2) may be bedridden ages 60 and above. Currently, the facility has six (6) residents and one (1) in hospice care. The facility is approved for (2) hospice residents. Facility is a 4 bedroom, 3 bathrooms, and a one-story house. The client bedrooms are spacious and will easily accommodate the client's furnishings. There is a backyard with a small table and 3 chairs. Outdoor passageways, walkways, driveways, steps, and patios are free from obstructions. LPA Calderon did not observe hazards, such as ladders, gardening tools and/or motorized equipment in the front, back and/or side areas of the facility. Residents Bedrooms: Bedrooms 1,3 have 2 beds and 2, and 4 will have one bed each, one chair, one-night stand, one lamp. Bedrooms 1,2,3 and 4 all comply with the requirement of 8 cubic feet of space. Bathroom1,2: Have a working toilet, wash basins, and walk-in shower. Bathroom #1, #2 shower have grab bars. LPA Calderon observed adequate lighting in hallway leading to bathrooms. Linens & Hygiene Supplies: Beds have the required linen/supplies which include pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored in hall closet was noted. Emergency Phone Numbers, Exit Plan & Menu: The telephone system is landline and operable. Emergency Disaster Plan and "See something, say something Let Us Know". Fire Extinguisher 1 mounted on the wall next to the kitchen. Food Service: Dishes, cups and flat ware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils are stored in a lock box located in the kitchen area. Food supply is adequate; stored in kitchen refrigerator and cabinets and consists of the following: A variety of Fresh and Canned fruit, vegetable, and meat food items. Smoke Detectors/carbon monoxide: 7 hard wired smoke detectors are operating & working. Appliances: Gas Stove, oven, microwave, washer, and dryer working. Refrigerator in the kitchen has a measured temperature of at least 37 degrees Fahrenheit for appropriate food storage. Freezer is at zero degrees Fahrenheit. The residence is equipped with central air and heat, and each client bedroom is individually climate controlled. Toxins: Locked/stored in a cabinet located in the kitchen. Water Temperature: Bathrooms’ water temperature tested at 110 F. and #2 at 110 F. degrees. Kitchen water temperature tested at 112 degrees. Medications, First-Aid Kit & Book: Medication administration records storage area, and first aid kit has been inspected, which are stored in lock box located in a cabinet adjacent the refrigerator, available for staff use but inaccessible to clients. Clients & Staff Files: Records of staff and clients shall be stored in a locked-in staff office, and the section has been inspected. Reading Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the client's use. LPA Calderon did not observe any pet or bodies of water at the facility. LPA Calderon did not observe delayed egress, chain locks or dead bolts on exits. LPA Calderon did not observe pad locks or other mechanisms which may be obstructions for safe and quick egress during an emergency on side gates and front exits. Pool/Jacuzzi & Pets: LPA Calderon did not observe any pet or bodies of water at the facility. Fire clearance: Fire Clearance was approved on 08/19/2024 for six (6) non-ambulatory elderly adults of which two (2) may be bedridden ages 60 and above. An exit interview was conducted, and a copy of this report has been furnished by the applicant Evangeline Agatep by hand. Accordingly, LPA Jose Calderon will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.the state’s words, verbatim · CDSS document, Oct 27, 2025

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census: 6 COMP II Participants: Rudolf Zarate, CEO; Evangeline Agatep, Administrator Interview Method: Telephone interview On 10/10/25, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Oct 10, 2025