191600451-4-11-2023-11-AS-WGIS-CQSN3Y-20230411100706

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191600451
Report Date: 04/10/2023
Date Signed: 04/11/2023 10:08:26 AM

Document Has Been Signed on 04/11/2023 10:08 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	SUNWEST GARDEN HOME		FACILITY NUMBER:	191600451
ADMINISTRATOR:	ANEL, LETICIA C.		FACILITY TYPE:	735
ADDRESS:	4532 W. 161ST. STREET		TELEPHONE:	(310) 371-8518
CITY:	LAWNDALE	STATE: CA	ZIP CODE:	90260
CAPACITY: 6		CENSUS: 4	DATE:	04/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Violeta Bawica		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	On 04/10/23, Licensing Program Analyst (LPA), Wendy Gibbs conducted and unannounced annual visit using the full CAREs tool. LPA met with Administrator, Violeta Bawica, and the purpose of today's visit was explained. There are currently 4 Regional Center Clients in placement. All clients are ambulatory. Structure The facility is a single-story home in a residential neighborhood. The facility consists of the following: Living room, dining area, kitchen, 3 client bedrooms, 1 staff room, 1 staff office, 1 staff bathroom, 1 1/2 client bathrooms, 1 storage room and laundry area. This facility is a duplex unit with adjacent duplex unit having a Adult Residential License #191600459. These facilities were licensed prior to the enactment of the over-concentration statute. Physical Plant The Administrator and LPA toured the facility inside and out. LPA observed all walkways to be clean, clear, and free of obstructions, hazards, and debris. All gates open easily to exit the grounds. LPA did not observe any bodies of water on the grounds. Bedrooms LPA toured all bedrooms. All bedrooms contained the required furniture including beds, dressers, night stand, chairs and ample space to store personal belongings, except for one room. Administrator explained that the resident has fallen multiple times because the bed was too high or furniture was in the way. The bed frame and the furniture were moved out of the room. All of the residents belonging are stored in the closet. All bedrooms were observed to be clean and in good repair. LPA checked the staff resident room. Linens & Hygiene LPA observed an ample supply of linens in the hall closet, including comforters, blankets, sheets and towels. LPA, observed an ample supply of hygiene products stored in the main bathroom. Resident's individual hygiene baskets are stored in the bathroom. Bathrooms LPA observed the bathrooms to clean and sanitary. All bathrooms had a working toilet, faucets, and shower. All showers had a non-skid mat and shower chairs are available for residents use. All bathrooms had an ample supply of hand soap and paper towel. All bathrooms have ample lighting. The water temperature in the main bathroom measured 115.9-degrees Fahrenheit. The water temperature in the

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: SUNWEST GARDEN HOME	FACILITY NUMBER: 191600451
	VISIT DATE: 04/10/2023

NARRATIVE

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private bathroom measured 113.4- degrees Fahrenheit.
Kitchen LPA toured the facility kitchen, and found it to be clean and sanitary. LPA observed all appliances, cutleries, pots and pans to be in good repair. LPA observed a 2-day supply of perishable foods and a
7-day supply of non-perishable foods. All cleaning supplies are stored under the sink and are inaccessible to residents. All knives and sharps are stored in a locked cabinet in the kitchen. The water temperature measured 117.6-degrees Fahrenheit.
Common Rooms LPA toured all common rooms. In the living room, LPA observed ample seating to accommodate all residents. There are movies, games and activities available for residents. The dining room has a large table to spaciously accommodate all residents. LPA observed all hallways and walkways to be clean, clear, and free of hazards or obstructions. All rooms are maintained at a comfortable temperature. LPA observed ample lighting in all rooms.
Safety The smoke detectors and carbon monoxide detectors were tested and are fully operable. There is a fully charged fire extinguisher mounted next to the kitchen door. Last emergency drill was on 1/18/22. LPA observed all required signs posted throughout the facility including emergency numbers and emergency plan. The facility has a working landline. LPA inspected the First Aid Kit and found it contained the required items and manual. There are no firearms or ammunition stored on the premises.
Infection Control LPA observed required infection control postings throughout the facility. LPA observed a 60-day supply of PPEs. All staff were observed wearing face coverings.

Medications Centrally stored medications were observed stored in their originally received containers and secured in a locked cabinet in the kitchen. LPA reviewed all Resident medications and matched them to the MARs.

Files LPA reviewed all resident files and found they contained the required documents. LPA reviewed 6 staff files and found they contained the required documents, training, and certification. LPA reviewed the training logs for all staff. LPA reviewed the P & I for the Residents. LPA reviewed the Surety Bond.

Interviews LPA interviewed Administrator and additional 4 staff. LPA talked with residents that were available. Majority of the residents are non-verbal, at day program and out of town with family.

One deficiency was cited, please see attached LIC809-D

An exit interview was conducted and a copy of this report was provided to Administrator.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/11/2023 10:08 AM - It Cannot Be Edited

Created By: Wendy Gibbs On 04/10/2023 at 04:38 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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SUNWEST GARDEN HOME	FACILITY NUMBER: 191600451
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/10/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

85088

This requirement is not met as evidenced by: 85088 Fixtures, Furniture, Equipment and Supplies (c) The licensee shall ensure provision to each client of the following furniture, equipment and supplies necessary for personal care and maintenance of personal hygiene. (2) Bedroom furniture including, in addition to (c)(1) above, for each client, a chair, a night stand, and a lamp or lights necessary for reading.
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in Bedroom 1 LPA observed only a bed and closet space for persoanl belongings which poses/posed a personal rights risk to persons in care.
	POC Due Date: 04/10/2023
	Plan of Correction
1 2 3 4	Administrator and staff moved the required furniture into the room while LPA was there.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Eva M Alvarez

LICENSING EVALUATOR NAME:

Wendy Gibbs

LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

LIC809 (FAS) - (06/04)

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