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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191500146
Report Date: 08/14/2023
Date Signed: 08/14/2023 02:41:16 PM


Document Has Been Signed on 08/14/2023 02:41 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:ARTESIA CHRISTIAN HOMEFACILITY NUMBER:
191500146
ADMINISTRATOR:MICHELLE ROBISONFACILITY TYPE:
741
ADDRESS:11614 EAST 183RD STREETTELEPHONE:
(562) 865-5218
CITY:ARTESIASTATE: CAZIP CODE:
90701
CAPACITY:143CENSUS: 81DATE:
08/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Director of Residential Care Services, Anne WalshTIME COMPLETED:
03:00 PM
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On 8/14/23 at 9:15 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced Annual/Required inspection to Artesia Christian Home. Upon arrival LPA was greeted by Director of Residential Services Anne Walsh and explained the reason for the visit. This facility is licensed to serve 115 residents age 60 and over with non-ambulatory capacity of 75. During today's visit LPA inspected the assisted living and memory care campus, reviewed the food supply, tested the smoke/carbon monoxide detectors, interviewed (5) staff, and interviewed (10) resident.

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. 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 105 *F- 118.5*F. 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 kitchen was toured and contained working appliances; refrigerator, stove, oven and contained dishware, cups, plates, utensils, pots, and pans with knives secured and locked. The pantry was well stocked, and the food supply contained a sufficient supply with a two-day supply of perishables and a seven-day supply of non-perishables that met title 22 guidelines. Walls and floors, cabinets and counters were clean and sanitary throughout the facility. LPA observed ample amount of PPE supplies in multiple storage rooms.

(Report continued on LIC809C.)

The outdoor grounds were toured and inspected, and the patio was well maintained with a shaded seating area accessible for client use. Upon return LPA will review medications, review staff and resident files, review staff training, and finalize care tools.



Exit interview conducted with Anne Walsh, Director of Residential Services, a copy of this report was provided.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2023
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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