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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600451
Report Date: 04/11/2024
Date Signed: 04/11/2024 02:37:12 PM

Document Has Been Signed on 04/11/2024 02:37 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:SUNWEST GARDEN HOMEFACILITY NUMBER:
191600451
ADMINISTRATOR/
DIRECTOR:		ANEL, LETICIA C.FACILITY TYPE:
735
ADDRESS:4532 W. 161ST. STREETTELEPHONE:
(310) 371-8518
CITY:LAWNDALESTATE: CAZIP CODE:
90260
CAPACITY: 6CENSUS: 4DATE:
04/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:46 AM
MET WITH:Administrator, Violeta BawicaTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 04/11/23, Licensing Program Analyst (LPA), David España conducted and unannounced annual Required 1 year 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. 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 bathroom, 1 storage room and laundry area. This facility is a duplex unit which the Adult Residential License #191600459 is located towards the back of the property. These facilities were licensed prior to the enactment of the over-concentration statute. 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 in or out of the facility. LPA toured all bedrooms. All bedrooms contained the required furniture including beds, dressers, nightstand, chairs and ample space to *store personal belongings, except for bedroom #1. Administrator explained that the resident has fallen multiple times because the bed was too high, or furniture was in the way. The bed frame is located in the room. LIC809-C
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2024
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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: SUNWEST GARDEN HOME
FACILITY NUMBER: 191600451
VISIT DATE: 04/11/2024
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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. 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. 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 112 degrees Fahrenheit. The water temperature in the private bathroom measured 114 degrees Fahrenheit. 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. 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. All rooms are maintained at a comfortable temperature. LPA observed ample lighting in all rooms. The smoke detectors and carbon monoxide detectors were tested and are fully operable. LIC809-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: SUNWEST GARDEN HOME
FACILITY NUMBER: 191600451
VISIT DATE: 04/11/2024
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 There is a fully charged fire extinguisher mounted next to the kitchen door.The facility conducted the last fire and earthquake emergency drill pursuant to Health and Safety Code section 1531.15(h) on 09/16/2023. LPA observed all required signs posting throughout the facility including emergency numbers and emergency plan. The facility has a working landline. LPA inspected the First Aid Kit and First Aid Kit Manuel and found it contained the required items. There are no firearms or ammunition stored on the premises. LPA observed required infection control postings throughout the facility. LPA observed a 60-day supply of PPEs. 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.

LPA reviewed all resident files and found they contained the required documents. LPA reviewed Five (5) staff files and found they contained the required documents, training, and certification. LPA reviewed the training logs for all staff. LPA reviewed Four (4) client P & I. LPA reviewed the Surety Bond. LPA interviewed Administrator. The clients were not available (day program). Majority of the residents are non-verbal, at day program and out of town with family.

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

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC809 (FAS) - (06/04)
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