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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191501668
Report Date: 02/24/2023
Date Signed: 02/24/2023 03:40:17 PM


Document Has Been Signed on 02/24/2023 03:40 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:BRITISH HOME IN CALIFORNIA LTD, THEFACILITY NUMBER:
191501668
ADMINISTRATOR:MARLENE RAINENFACILITY TYPE:
741
ADDRESS:647 MANZANITA AVETELEPHONE:
(626) 355-7240
CITY:SIERRA MADRESTATE: CAZIP CODE:
91024
CAPACITY:41CENSUS: 30DATE:
02/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Jane Adams, Nursing ManagerTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection with the focus of the Infection Control domain. LPA met with the Nursing Manager, Jane Adams, and explained the purpose of the visit.
The facility is approved for a capacity of 41 and serves elderly ages 60 and above. There can be 34 ambulatory with a maximum of 7 non-ambulatory residents, restricted to the Braemar Cottage. The facility may retain 2 hospice residents.

LPA Chan toured the campus and observed the following:
* There are 6 different cottages (Foskett, Ramona, Lambert, Shafer, Braemar, and Jameson) and each contains resident rooms, living room, small dining room, kitchen, and a laundry room. The main dining room and kitchen are located at the Armstrong building. Signage are posted by the entry points of each building and in the kitchen and common bathrooms. LPA randomly selected 6 resident rooms to inspect. They are clean and have the required furnishings. There are no pool or bodies of water on the premises. There are no items obstructing the walkways. The facility has proper Coronavirus (COVID-19) signage throughout the facility. LPA recommended to put additional signage such as cough/sneeze etiquette in the cottages and communal areas. Hand washing signs are posted in each of the bathrooms and kitchen sink. Sufficient PPE supplies are stored at the facility. Food supplies for 2 day perishable and a week of non-perishable were observed. Medications are centrally stored and locked in the med room located in the Jameson cottage. LPA reviewed medications for 6 residents and staff are administering them as prescribed by the physician. Emergency contact information for residents are current and emergency contact numbers are posted. All staff on duty were wearing face masks.

No deficiencies were observed during the visit today. An exit interview was held and a copy of this report was provided to staff Jane Adams.
SUPERVISOR'S NAME: Tony VasalloTELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D ChanTELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:
DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/24/2023
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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