191501668-12-16-2021-28-AS-JKAN-C9QVVP-20211215154636

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191501668
Report Date: 12/15/2021
Date Signed: 12/16/2021 07:22:46 AM

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:	BRITISH HOME IN CALIFORNIA LTD, THE		FACILITY NUMBER:	191501668
ADMINISTRATOR:	MARLENE RAINEN		FACILITY TYPE:	741
ADDRESS:	647 MANZANITA AVE		TELEPHONE:	(626) 355-7240
CITY:	SIERRA MADRE	STATE: CA	ZIP CODE:	91024
CAPACITY:	41	CENSUS: 31	DATE:	12/15/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Staff / Rosario Munoz & Carrie Crowley Executive Director / Marlene Rainen		TIME COMPLETED:	04:00 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) Joe Katrdzhyan conducted a site visit for the Required - 1 Year inspection. Upon arriving at the facility, LPA met with Staff / Rosario Munoz and Carrie Crowley and was later joined by the Executive Director / Marlene Rainen who assisted with the visit. The facility is licensed to serve for a capacity of 41 residents (34 Ambulatory and 7 Non-Ambulatory only) ages 60 and above. The facility does NOT have an approved fire clearance for residents who may be bedridden. The facility has an approved Hospice Waiver on file for two (2) Residents. There are currently two (2) Residents on Hospice. British Home in California LTD does not have an approved Dementia Care Plan in their plan of operation and does not accept residents with dementia. LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. During the tour, LPA was accompanied by Rosario Munoz. A tour of the facility consists of a campus style setting that has six (6) cottages for residents and a separate building (Armstrong) which is used as a lounge/living room/dining room. The cottages are named Foskett, Ramona, Lambert, Braemar, Jameson, and Shafer. Each cottage has private resident bedrooms and bathrooms; its own living, dining, kitchen and laundry area. The front grounds of the facility are well landscaped and have a leveled walkway to the entrance. No large bodies of water were observed. There are no security bars or weapons on the premises. The facility has central air and heating accommodations. LPA toured a random selection of resident rooms in each cottage. Resident rooms were furnished appropriately. Each resident room has their own bathroom. The bathrooms were observed to be clean and operational w/grab bars. The resident rooms have signal systems located in each bathroom and facility phones to call the front desk. The signal system was tested in various locations and is operable. The hot water temperature was tested throughout the facility and measured within Title 22 Regulation guidelines. The facility has central air and heating accommodations. (Please see LIC 809C for additional information)

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Joe Katrdzhyan	TELEPHONE: (323) 981-3968
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BRITISH HOME IN CALIFORNIA LTD, THE	FACILITY NUMBER: 191501668
	VISIT DATE: 12/15/2021

NARRATIVE

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The kitchen was observed. There was a sufficient amount of perishable and non-perishable food supplies and perishable food was stored in covered containers at the appropriate temperatures. No pesticides or poisons were stored in the food areas. Storage areas for cleaning solutions, toxics, knives, and hazardous items were secured and made inaccessible to Residents. The fire extinguishers were observed to be fully charged and in compliance. The facility has carbon monoxide detectors in each resident room. A shaded area with chairs is provided to the residents.

Medications are centrally stored in the locked medication room located in the Jameson cottage. A random selection of medications were reviewed to ensure they are being administered as prescribed.

No deficiencies were observed during this visit
An exit interview was conducted and a copy of this report was provided to the Executive Director.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Joe Katrdzhyan	TELEPHONE: (323) 981-3968
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

LIC809 (FAS) - (06/04)

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