191600341-4-7-2022-11-AS-LMOA-CD9LS5-20220407090011

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191600341
Report Date: 03/30/2022
Date Signed: 04/07/2022 09:00:22 AM

Document Has Been Signed on 04/07/2022 09:00 AM - 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 DR #100
MONTERY PARK, CA 91754

FACILITY NAME:	HUNTINGTON RETIREMENT HOTEL		FACILITY NUMBER:	191600341
ADMINISTRATOR:	HEATHER ARGUETA		FACILITY TYPE:	740
ADDRESS:	20920 EARL STREET		TELEPHONE:	(310) 370-5828
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90503
CAPACITY:	155	CENSUS: 70	DATE:	03/30/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:53 AM
MET WITH:	Corina Kahl/Heather Argueta		TIME COMPLETED:	01:50 PM

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On 3/30/2022, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA called and spoke with Administrator Heather Argueta who verified that the facility is free of Covid-19. Upon arriving at the facility, LPA met with Resident Coordinator (RC) Corina Kahl, who granted access and allowed LPA to enter the facility to conduct an annual inspection. Administrator Heather Argueta later arrived and assisted with the visit.

The facility is licensed to serve up to 155 clients 60 years or older, 5 of which may be bedridden, and 30 of which may be non-ambulatory and this facility has an approved hospice waiver for 12 terminally ill residents. The current staff census was 61 and the resident census was 70 at the time of visit, The facility handles residents’ cash resources. Facility Annual Fees are current during today’s visit. The administrator’s certificate expires on 11/25/2023.

During the visit, LPA toured the facility with RC Corina Kahl. LPA randomly inspected 13 resident bedrooms, the kitchen, 2 dining rooms, living room, pantry, chapel, library, medication room, TV/Entertainment room, indoor activity areas, and outdoor patios. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. There are working lights or lamps in each room at the time of visit. There are grab bars for each toilet and shower used by residents. Showers have non-skid mats.

LPA tested the pull emergency cord notification system of the resident in bedroom # 123 and observed the caregiver responded within 2 minutes and turned off the signal.

REPORT CONTINUED IN LIC 809C

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (323) 981-4934
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

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 DR #100
MONTERY PARK, CA 91754

FACILITY NAME: HUNTINGTON RETIREMENT HOTEL	FACILITY NUMBER: 191600341
	VISIT DATE: 03/30/2022

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LPA checked resident bedrooms 212, 249, 114, 137 121 and observed the hot water temperatures are within 105 degrees Fahrenheit and 120 degrees Fahrenheit which are in compliance with Title 22.

LPA observed a two-day supply of perishable and a one-week supply of non-perishable food. There are additional refrigerators and freezers in the pantry area which contain emergency storage of food supplies and water. The kitchen is clean, organized, and sanitary. All storage areas for cleaning solutions, toxins, knives, and hazardous items are in a secured cabinet and inaccessible to residents.

LPA observed the smoke detectors were tested by the maintenance supervisor and they were operable. Two operable carbon monoxide detectors located on the first floor and two detectors on the second floor were observed. Fire extinguishers were last serviced on 11/11/2021. The last facility fire drill was conducted on 3/9/2022.

There are no pools or bodies of water on the premises. There are no firearms on the premises or other dangerous weapons. Potentially dangerous items are kept inaccessible to residents with dementia. Centrally stored medications are locked in the medication room. The first aid kit has all the required supplies. Toxic chemicals are locked and inaccessible to residents with dementia. The facility has a written emergency disaster plan posted at the entrance of facility. The facility is maintained at a comfortable temperature.

During the visit, LPA observed the following to be in compliance: the facility's infection control practices; screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms; every staff was wearing a face covering; the facility has a 30-day supply of Personal Protective Equipment (PPE) stored in a vacant room (#217). All mandated inspection control posters were posted. The facility has a Mitigation Plan Report approved by CCLD.

Exit interview conducted. A copy of this report was provided to Administrator Heather Argueta.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (323) 981-4934
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

LIC809 (FAS) - (06/04)

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