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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600459
Report Date: 07/19/2022
Date Signed: 07/22/2022 08:33:35 AM

Document Has Been Signed on 07/22/2022 08:33 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
MONTEREY PARK, CA 91754
FACILITY NAME:SUNWEST GARDEN HOMEFACILITY NUMBER:
191600459
ADMINISTRATOR:ANEL, LETICIA C.FACILITY TYPE:
735
ADDRESS:4534 W. 161ST STREETTELEPHONE:
(310) 371-8518
CITY:LAWNDALESTATE: CAZIP CODE:
90260
CAPACITY: 6CENSUS: 3DATE:
07/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:Sony BawicaTIME COMPLETED:
01:03 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced Annual inspection visit and infection control inspection to the above facility. LPA was met by Violeta Bawica Administrator the purpose of today’s visit was explained.

There are currently (6) Regional Center consumers in placement. All (6) clients are ambulatory. The facility is a single-story structure located in a residential neighborhood. It consists of the following: 4 bedrooms, 1 and 1/2 bathrooms, family room/office, living room, kitchen, dining room, shaded area, indoor and limited outdoor activity area, laundry room and attached garage.

LPA and Administrator toured the entire facility inside and out. Documents are posted as mandated by the DPH and CCLD. Bedrooms 1 – 3 are occupied by clients and contain the mandated furniture. The bathrooms are partially clean and operational. Smoke detectors and carbon monoxide detector are in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to clients. 1 staff file is current, 1 resident file is current along with medications. The water temperature is at 110 degrees. A comfortable temperature is maintained in the facility. Ample supply of perishable and nonperishable food, linens and personal hygiene supplies are adequate, hazardous toxins and/or items are inaccessible to clients, 1 fire extinguishers are fully charged. First Aid kit complete and with manual. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair. During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry, sanitizer/soap in the staff bathroom and additional sanitation supplies in a locked cabinet located in the garage. LPA observed staff and clients wearing masks, clients share in their rooms two clients per room, required postings throughout the facility. The administrator advised LPA that sanitizer is administered to client with the supervision of staff, but sanitizers are not kept in their rooms for safety reasons. The facility has an approved Mitigation plan. Visitors are logged and checked. The client’s temperatures are checked and logged 2x a day. LPA noticed Flooring chipped and broken or separating flooring in all rooms and kitchen area has grease splatter in prep and cooking area, as well as the walls have grease and food splatter. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA observed the deficiencies and issued citations.

An exit interview conducted with Bawica Administrator, Administrator and copy of report provided

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jeremiah Randle
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2022
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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Document Has Been Signed on 07/22/2022 08:33 AM - It Cannot Be Edited


Created By: Jeremiah Randle On 07/19/2022 at 11:58 AM
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: 191600459

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

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 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/19/2022
Plan of Correction
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Repair Flooring chipped and broken or separating flooring in all rooms.
Type B
Section Cited
CCR
80076(a)(17)
Food Service
(a) In facilities providing meals to clients, the following shall apply: (17) All kitchen, food preparation, and storage areas shall be kept clean, free of litter and rubbish, and measures shall be taken to keep all such areas free of rodents, and other vermin.

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 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/26/2022
Plan of Correction
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Clean Kitchen area grease splatter in prep and cooking area, as well as the walls have grease and food splatter. Bathrooms stains general cleaning.
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:Janae Hammond
LICENSING EVALUATOR NAME:Jeremiah Randle
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2022


LIC809 (FAS) - (06/04)
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