191500146-7-30-2024-28-AS-CWOG-D7NUGJ-20240730153425

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191500146
Report Date: 07/30/2024
Date Signed: 07/30/2024 03:35:24 PM

Document Has Been Signed on 07/30/2024 03:35 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:	ARTESIA CHRISTIAN HOME		FACILITY NUMBER:	191500146
ADMINISTRATOR:	MICHELLE ROBISON		FACILITY TYPE:	741
ADDRESS:	11614 EAST 183RD STREET		TELEPHONE:	(562) 865-5218
CITY:	ARTESIA	STATE: CA	ZIP CODE:	90701
CAPACITY:	143	CENSUS: 80	DATE:	07/30/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Anne Walsh		TIME COMPLETED:	03:50 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Christine Wong conducted the Unannounced required annual inspection. LPA arrived unannounced and met with Director of Residential Services Anne Walsh and assisted with the visit. The purpose for the visit was explained. The facility is approved to serve 40 ambulatory and 95 non-ambulatory, and 8 residents with bedridden, hospice waiver approved for 8. Currently there's about 8 residents on hospice and 7 residents on home health. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: 1. Infection Control: The facility staff are using appropriate hand hygiene and wearing gloves while assisting residents. Staff are cleaning and disinfecting once a day and more often for high touched surfaces. Facility has sufficient PPE supplies and has an updated Infection Control Plan in place. LPA reviewed staff files and all staff has the update health screening and TB test result in file. 2, Operational Requirement: The current plan of operation is completed. The facility has a Dementia Waiver in place. A Hospice Waiver for 8 residents is approved. A fire clearance approved for 40 ambulatory, 95 non-ambulatory and 8 residents with bedridden Currently there's probably one resident is bedridden. Liability Insurance in the amount of at least ($1,000,000) per occurrence and total amount of aggregate ($3,000,000) is in place. 3. Physical Plant and Environmental Safety: The facility consists of two campuses, (1) for memory care and (1) for assisted living. Assisted living is two (2) stories with 44 bedrooms, 2 communal showers, activity rooms, medication room, offices, salons, Kitchen, and a dinning room. The memory care campus is a single-story building with 22 bedrooms with private bathrooms, salons, activity room, kitchen, medication room and dining room. For Assisted Living, LPA inspected two rooms in North Station with Room# 118 and #112 and three rooms in South Station with Room#201, #216 and #142. The resident bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Resident beds have the required linen, and the linen is in good condition. The bathrooms contain a working toilet, basin, and water faucet, walk in shower with grab bar, skid matt/strips and shower chair. The temperature measured at 110.1 and 119.5 degrees F which is within the Title 22 regulation.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ARTESIA CHRISTIAN HOME	FACILITY NUMBER: 191500146
	VISIT DATE: 07/30/2024

NARRATIVE

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For Memory Care unit, LPA inspected East Wing with Room# #303, #305 and West Wing with Room#329 and all the resident rooms have the required furniture and beddings. The resident bathrooms are clean, sanitary and in a good working condition and with required grab bar and non-skid mat. The hot water temperature tested in these residents' rooms are around 105 degrees F which is within the Tittle 22 regulation. The smoke detectors were tested and observed to be working properly. The carbon monoxide detector was tested and functioning properly. There were fire extinguishers located throughout the facility, fully charged and up to date. The outdoor grounds were toured and inspected, and the patio was well maintained with a shaded seating area accessible for residents to use.

4. Staffing: The facility has sufficient staffing in the facility. Each shift, the facility staff has at least one staff is having the updated First Aid/CPR Certificate in file.

5. Personal Record-Training: LPA reviewed eight (8) Staff file sand they are all over 18 years old, background check /fingerprint cleared and associated with the facility and they all have the required documents included: employee application, required training hours , health screening and TB test result in file. LPA reviewed the Director of Residential Services and her administrator certificate was expired on 2/23/24 but currently her application is pending with the CCL system

6. Resident's Right Information: LPA observed the required posters posted in the facility Assisted Living side which include Long Term Care Ombudsman, Licensing Complaint Poster and Resident Right Poster are located near the resident's mail box near the facility main entrance area. For the memory care unit, all the required posters are located near the reception area near the West Wing. The residents also have internet service for at least one internet access device for residents to communicate with their family members or physician.

7. Planned Activity: Facility has sufficient space to accommodate for indoor and outdoor activity. LPA also observed the weekly activity calendar and it's posted in the facility both Assisted Living side and Memory Care unit. The facility does have an active Resident Council.

8. Food Services: Currently the facility has about 5 residents on soft food and 1 resident on puree food who are required the modified diet and they are all in Memory Care Unit and LPA reviewed and observed the doctor's order. The facility has ample supply for two days perishable and seven days non-perishable food supply. The facility also has emergency food supplies and water located on both Assisted Living and Memory Care Unit. All the food are stored properly. The kitchen was toured and contained working appliances; refrigerator, stove, oven and contained dishware, cups, plates, utensils, pots, and pans with knives secured and locked. Walls and floors, cabinets and counters were clean and sanitary throughout the facility. LPA also reviewed and observed the dietary director handling certificate and it will be effective through year 2028.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ARTESIA CHRISTIAN HOME	FACILITY NUMBER: 191500146
	VISIT DATE: 07/30/2024

NARRATIVE

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8. Food Services: Currently the facility has about 5 residents on soft food and 1 resident on puree food who are required the modified diet and they are all in Memory Care Unit and LPA reviewed and observed the doctor's order. The facility has ample supply for two days perishable and seven days non-perishable food supply. The facility also has emergency food supplies and water located on both Assisted Living and Memory Care Unit. All the food are stored properly. The kitchen was toured and contained working appliances; refrigerator, stove, oven and contained dishware, cups, plates, utensils, pots, and pans with knives secured and locked. Walls and floors, cabinets and counters were clean and sanitary throughout the facility. LPA also reviewed and observed the dietary director handling certificate and it will be effective through year 2028.

9. Incidental Medical and Dental: The facility would assist resident to arrange dental and doctor appointment and transportation if needed. LPA inspected Eight (8) resident's medication and they are all centrally stored in the Wellness Office and they seemed accurate and update and with 30 days supply of medication.

10. Disaster Preparedness: The facility has an updated LIC610E (Emergency Disaster Plan) in file and they reviewed annually. The last fire drill was conducted on 7/13/24 for Assisted Living and 7/15/24 for Memory Care Unit. The facility also has two appropriate shelter location for emergency. Records of resident Appraisal and Needs services plans are part of Emergency training.

11. Resident's Records-Incident Reports: LPA inspected 8 residents' files including Assisted Living and Memory Care Unit. All resident's files have the required documents which include Face Sheet, Pre-Admission Appraisal, Needs and Service Plan, Physician Report, Medical Consent form, TB Test Result, Admission Agreement, Ambulatory Status and Medication Record.

12. Residents with Special Health Needs: Eight (8) residents are receiving hospice services. Seven (7) residents receive home health services. No resident in the facility is on any postural support. Half bed rails for mobility assistance were observed in some resident rooms in Memory Care Unit. Individual Service Plans and Appraisals are on file. No residents have prohibited health conditions.

No deficiencies were observed during the visit

Exit Interview conducted and a copy of the report was provided to the Director of Residential Services.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

LIC809 (FAS) - (06/04)

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