191600341-10-1-2023-11-AS-ARID-CW7U86-20231001152101

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191600341
Report Date: 10/01/2023
Date Signed: 10/01/2023 03:21:11 PM

Document Has Been Signed on 10/01/2023 03:21 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY 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: 104	DATE:	10/01/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:22 AM
MET WITH:	Heather Argueta		TIME COMPLETED:	03:35 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

On 09/28/2023, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced annual required visit using the new CARE Inspection Tool. LPA called and spoke with Administrator Heather Argueta Upon arriving at the facility, LPA met with Resident Coordinator (RC) Corina Kahl and explained the purpose of today's visit. 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 30 and the resident census was 103 at the time of visit, The Facility Annual Fees are current during today’s visit. The administrator’s certificate expires on 11/25/2023.

During the visit, LPA Richard toured the facility with RC Corina Kahl. LPA randomly inspected 11 resident bedrooms, the kitchen, 2 dining rooms, living room, pantry, library, chapel, pool room, 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 # 111 and observed the caregiver responded within 2 minutes and turned off the signal.

REPORT CONTINUED IN LIC 809C

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonine Richard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2023

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 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: HUNTINGTON RETIREMENT HOTEL	FACILITY NUMBER: 191600341
	VISIT DATE: 10/01/2023

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
26
27
28
29
30
31
32

LPA checked resident bedrooms 220, 217, 210, 207, 202, 136, 115, 114, 111, 104, 102 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 08/31/2023. The last facility fire drill was conducted on 09/14/2023.

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; 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. 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: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonine Richard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2