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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191593145
Report Date: 02/13/2024
Date Signed: 02/13/2024 04:34:43 PM

Document Has Been Signed on 02/13/2024 04:34 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:NEW DAY ASSISTED LIVINGFACILITY NUMBER:
191593145
ADMINISTRATOR:CRUZ, JUANFACILITY TYPE:
735
ADDRESS:9555 RAMONA STTELEPHONE:
(562) 867-1002
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 29CENSUS: 18DATE:
02/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:43 AM
MET WITH:Juan Cruz, Administrator TIME COMPLETED:
04:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA explained the purpose of the visit to Administrator Juan Cruz. The facility is licensed for ambulatory only residents 18-59 years old. The facility formerly known as "Ramona Guest Home - Bellflower" had a change of management company and Administrator change that was effective 1/16/2024. A change of ownership application was submitted and is pending.

During today's visit the following was completed:

NOTE: Only Type A citations were issued today.

  • LPA toured the interior and exterior physical plant. Fifteen (15) resident rooms, 2 live-in staff rooms, all common areas, activity rooms, common bathrooms, kitchen/med-tech room, dining room, laundry room, pantry room/storage room, and laundry room were inspected. The side corridor/yard exit area gate has an unapproved lock on the door preventing egress because it requires a key, and the Administrator does not have a key to the lock. Citation was issued.
  • Water temperature readings throughout the three (3) facility buildings did not measure between the required 105 - 120 degrees Fahrenheit. Temperatures ranged between 125 DF - 142.2 DF. Citation was issued.
  • Review of medications and Medication Administration Records was completed. Residents (R1) had a PRN medication in their room that does not have a physician order. Citation was issued.
  • Staff Criminal Record clearance was checked. Staff (S1) has worked at the facility since 2014 and is not associated. Citation and civil penalty was issued.
  • Upon return LPA will finish reviewing resident files and will review all staff files. Resident interviews are pending.

Due to time constraints, an annual continuation visit will be conducted at a future date.

Exit interview was conducted with Administrator Juan Cruz. A copy of the report and appeal rights were issued.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 02/13/2024 04:34 PM - It Cannot Be Edited


Created By: Noemi Galarza On 02/13/2024 at 03:59 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: NEW DAY ASSISTED LIVING

FACILITY NUMBER: 191593145

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 02/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that water temperature readings throughout the three (3) facility buildings ranged in temperatures of 125 DF - 142 DF; which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/14/2024
Plan of Correction
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Administrator shall adjust the water boilers and submit a hot water temperature log indicating the water was tested 3 times a day. Submit pictures of the hot water temperature readings. POC is due tomorrow.
Type A
Section Cited
CCR
80019(e)(3)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 80019(f) or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that staff (S1) is not associated to the facility; which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/14/2024
Plan of Correction
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Staff (S1) shall be associated to the facility by tommorow via Guardian or staff can drop off transfer request at CCL office. Civil penalty was assessed.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Hicks
LICENSING EVALUATOR NAME:Noemi Galarza
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 02/13/2024 04:34 PM - It Cannot Be Edited


Created By: Noemi Galarza On 02/13/2024 at 03:59 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: NEW DAY ASSISTED LIVING

FACILITY NUMBER: 191593145

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 02/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80075(k)(1)
Health-Related Services
(k) The following requirements shall apply to medications which are centrally stored: (1) Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation/record review, the licensee did not comply with the section cited above in that resident (R1's) PRN medication (Ibuprofen 800 mg) was observed in the resident't room and also did not have a MD order on file; which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/14/2024
Plan of Correction
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Staff immediately removed the medication from R1's room and stored it in the med-room cabinet.
1. Submit a written plan of correction that includes staff training (staff signatures)
Type A
Section Cited
CCR
80072(a)(7)
Personal Rights
Each client has the right not to be locked in any room, building, or facility premises by day or night.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation during outdoor physical plant inspection, the licensee did not comply with the section cited above in that LPA observed the side yard egress door has a lock on the inside of the door, which requires a key. Administrator does not have a key to the lock; which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/14/2024
Plan of Correction
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Administrator shall ensure that all exit gates are able to be opened from the interior of the facility. No locking mechanism that requires a key from the inside of the facility shall be placed in exterior egress doors. Submit picture proof that the lock was removed.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Hicks
LICENSING EVALUATOR NAME:Noemi Galarza
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2024


LIC809 (FAS) - (06/04)
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