191801803-8-27-2024-28-AS-SVAD-D8JT6Z-20240827142758

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191801803
Report Date: 08/27/2024
Date Signed: 08/27/2024 02:28:04 PM

Document Has Been Signed on 08/27/2024 02:28 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	GARDEN CREST		FACILITY NUMBER:	191801803
ADMINISTRATOR:	CAROL ICE		FACILITY TYPE:	740
ADDRESS:	889 LUCILE AVE		TELEPHONE:	(323) 663-8281
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90026
CAPACITY:	44	CENSUS: 26	DATE:	08/27/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:12 AM
MET WITH:	Laura Ghazarian, Administrator		TIME COMPLETED:	02:45 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	Licensing Program Analyst (LPA) S Vaid conducted the required annual inspection. LPA arrived unannounced and met with Lorra Ghazarian (Administrator) and explained the purpose of today’s visit. The facility is licensed to serve 44 residents over the age of 60 of which up to 18 may be non-ambulatory residents, is approved for 4 hospice waivers, and 6 bedridden in assigned rooms. The facility is a two story building located in Los Angeles, CA. A tour of the facility includes: First Floor: 13 resident rooms, tv room, 2 public restrooms, 2 shower rooms, janitor closet and linen closet. Second Floor: lobby / tv room, kitchen, dining/activity room, library/ laundry room, 2 common shower rooms, 2 staff bathrooms, 9 resident rooms (with private bathrooms), nurse station (medication room), janitor closet and linen closet. Facility has multiple fire extinguishers and carbon monoxide detectors with a sprinkler fire system throughout the facility. LPA interviewed five (5) staff and four (4) residents on today’s visit. LPA utilized the Compliance and Regulatory Enforcement tools for the visit today and observed the following: Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents’ medications. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and there is an Infection Control Plan on file. Operational Requirements: The facility maintains a plan of operation and has the required liability insurance on file. Physical Plant & Environment Safety: Smoke detectors and carbon monoxide detectors are operable and in compliance. Bathrooms are clean and operational. Residents’ bedrooms were observed to have reasonable accommodations each clients comfort was available. Nonskid mats were observed in shower rooms and residents’ private bathrooms. The outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available. The hot water temperature was tested throughout the facility and measured within the required range of 105-120 degrees. (Continued on 809-C)

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 916-215-7924
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024

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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GARDEN CREST	FACILITY NUMBER: 191801803
	VISIT DATE: 08/27/2024

NARRATIVE

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All storage areas for cleaning solutions, toxins, knives, and hazardous items are stored in a secured/locked area and inaccessible to residents. The last Fire/Emergency Drill was conducted on 8/13/24 and 08/19/24 respectively. The fire extinguisher was observed and is fully charged. Facility has telephone service on premises. Staffing: There appears to be sufficient staffing at all times in the facility with at least one CPR trained employee on the premises at all times. Administrator Edwin Villanueva certificate expires 12/17/2025. Personnel Records-Training: Staff has criminal record clearance, current first aid and CPR, and ongoing training. Staff files are maintained at the facility and kept in the Nurse Station. During todays visit LPA observed 4 staff files with no issues. Resident Records-Incident Reports: Resident files are kept in a secure location within the Nurse Station and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan. LPA observed 4 resident files during todays visit with no issues.
Resident Rights-Information: Complaint and Personal Rights posters were observed in hall-way. Residents are provided with telephone and internet at the facility. Planned Activities: There is an activity schedule posted outside the activity/dining room, LPA observed residents engaging in a exercise activity during today’s visit. There are board games and books readily available for residents in the library.
Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables.
Incidental Medical & Dental: All medications for residents are kept locked and inaccessible to other residents. Medication is properly labeled and are centrally stored in a locked cabinet and are in their original containers. During the visit today, LPA reviewed 4 residents’ medication no issues were observed.
Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites. The facility does have evacuation chair at each stairwell.
Residents with Special Health Need: “No smoking oxygen In Use” signs are properly posted. There are no bedridden or residents or residents with postural supports at this facility.

No deficiencies were noted on today's visit, copy of this report was left with Karla Yumal (Interim Administrator/ Business Office Manager).

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Sanjay Vaid	TELEPHONE: 916-215-7924
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024

LIC809 (FAS) - (06/04)

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