191600459-4-17-2024-11-AS-DESA-D4EUAG-20240417152443

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191600459
Report Date: 04/17/2024
Date Signed: 04/17/2024 03:24:55 PM

Document Has Been Signed on 04/17/2024 03:24 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 HOME		FACILITY NUMBER:	191600459
ADMINISTRATOR/ DIRECTOR:	ANEL, LETICIA C.		FACILITY TYPE:	735
ADDRESS:	4534 W. 161ST STREET		TELEPHONE:	(310) 371-8518
CITY:	LAWNDALE	STATE: CA	ZIP CODE:	90260
CAPACITY: 6		CENSUS: 5	DATE:	04/17/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:43 AM
MET WITH:	Violeta "Sony" Bawica Administrator		TIME VISIT/ INSPECTION COMPLETED:	03:45 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 04/17/2024 at 8:40 am Licensing Program Analyst (LPA) David España conducted an unannounced Required-1-year annual visit. Upon arrival at the facility, LPA España conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection (No COVID-19 cases). LPA España verified that the facility has an approved mitigation plan report. LPA España was granted access and allowed to enter the facility to conduct the inspection. On today's visit LPA España met with facility Violeta "Sony" Bawica Administrator. There are currently Five (5) Westside 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, Three (3) client bedrooms, One (1) staff room, One (1) staff bathroom, One and half (1 1/2) client bathroom(s), this facility is a duplex unit with adjacent duplex unit having an Adult Residential License #191600451. These facilities were licensed prior to the enactment of the over-concentration statute. The Violeta "Sony" Bawica Administrator and LPA España toured the facility inside and out. LPA España observed all walkways to be clean, clear and free of obstructions, hazards, and debris. All gates open easily to exit the grounds. LPA España did not observe any bodies of water on the grounds. Facility Evaluation Report LIC-809C Continued

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024

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: 191600459
	VISIT DATE: 04/17/2024

NARRATIVE

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LPA España toured all bedrooms. All bedrooms contained the required furniture including beds, dressers, nightstand, chairs and ample space to store personal belongings. All bedrooms were observed to be clean and in good repair. LPA España checked the staff client room. LPA España observed an ample supply of linens in the hall closet, including comforters, blankets, sheets and towels. LPA España observed an ample supply of hygiene products stored in the main bathroom. LPA España 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 client(s) use. All bathrooms had an ample supply of hand soap and paper towel. The main client bathroom, with the shower, has the client(s) toiletries stored in personal baskets. All bathrooms have ample lighting. The water temperature in the main bathroom measured 105.5 degrees Fahrenheit. The water temperature in the private bathroom measured 105.6 degrees Fahrenheit. LPA España toured the facility kitchen and found it to be clean and sanitary. LPA España observed all appliances, cutleries, pots and pans to be in good repair. LPA España 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 España toured all common rooms. In the living room, LPA España 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 España observed all hallways and walkways to be clean, clear, and free of hazards or obstructions. Facility Evaluation Report LIC-809C Continued

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024

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: 191600459
	VISIT DATE: 04/17/2024

NARRATIVE

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All rooms are maintained at a comfortable temperature. LPA España observed ample lighting in all rooms. The smoke detectors and carbon monoxide detectors were tested and are fully operable. There is a fully charged fire extinguisher mounted in the kitchen. Last emergency drill was on 09/16/2023. LPA España observed all required signs posted throughout the facility including emergency numbers and emergency plan. The facility has a working landline. LPA España inspected the First Aid Kit and found it contained the required items and manual. There are no firearms or ammunition stored on the premises. LPA España observed required infection control postings throughout the facility. LPA España observed a 60-day supply of PPEs. All staff were observed wearing face coverings. Centrally stored medications were observed stored in their originally received containers and secured in a locked cabinet in the kitchen. LPA España all client medications and matched them to the MARs. LPA España reviewed all client files and found they contained the required documents. LPA España reviewed Five (5) staff files and found they contained the required documents, training, and certification. LPA España reviewed the training logs for all staff. LPA España reviewed the P & I for the Clients. LPA España reviewed the Surety Bond. LPA España interviewed Administrator. LPA España did not interview clients they were not available. All clients are non-verbal and left to day program. There were One (1) Advisory Note(s)-Technical Violation: Food Service - Technical Violation: 80076(a)(19) - LPA España met with facility Violeta "Sony" Bawica Administrator and toured kitchen and observed stovetop appliance burner (gas powered) One (1) out of Four (4) to be defective (switch). An exit interview was conducted, and a copy of this report was provided to Violeta "Sony" Bawica Administrator.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE:	DATE: 04/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024

LIC809 (FAS) - (06/04)

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