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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191221839
Report Date: 11/09/2022
Date Signed: 11/09/2022 03:01:21 PM


Document Has Been Signed on 11/09/2022 03:01 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:BROADVIEW RESIDENTIAL CARE CENTERFACILITY NUMBER:
191221839
ADMINISTRATOR:BETSY K DAVISFACILITY TYPE:
740
ADDRESS:535 WEST BROADWAYTELEPHONE:
(818) 246-4951
CITY:GLENDALESTATE: CAZIP CODE:
91204
CAPACITY:180CENSUS: DATE:
11/09/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Administrator - Betsy DavisTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Ashley conducted an announced informal Teams meeting visit regarding COVID 19 recommendations and guidelines. LPA Calderon conducted the visit virtually with Administrator Besty Davis, Department of Public Health Outbreak Management Branch Representative, Alan Garcia, Brenna De Leon, and Dr. Al-Ahmad.

LPA Calderon, conducted a tour of the facility with Alan Garcia, Brenna De Leon and Betsy Davis and observed the following:

Entrance had thermometer, hand sanitizer and Covid-19 symptom log in book.


Facility is currently following Covid-19 (infection control) recommendations. No vaccination shots / booster issues.
Staff were observed wearing face masks and no staff shortages. .
Residents are placed in green zone – 35 residents, yellow zones- 1 resident and red zone- 18 residents.
Staff do not have direct contact with residents in the yellow and red zones, residents are independently living residents.
Sufficient PPE for 60 days and PPE located outside of rooms and trash cans with lids in the rooms.
Facility has appropriate Covid-19 signs throughout the facility as well as hand sanitizing stations.
Kitchen uses disposable utensils, plates and cups for meals, getting delivered to yellow and red zones.
Dining room area open only to green zone residents.
Laundry is done by staff, wear PPE while washing residents’ clothes, each resident gets individual washing services.

Recommendations from Public Health: change air filter and leave on air conditioner 24/7 to help viral partials and help with the air flow.

No deficiencies were given during this visit. Exit interview was conducted with Betsy Davis and a copy of this report will be mailed to the facility.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Ashley CalderonTELEPHONE: (323) 981-3984
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2022
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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