191802082-6-15-2021-31-AS-MBEY-C3ZTYM-20210615150858

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191802082
Report Date: 06/15/2021
Date Signed: 06/15/2021 03:10:25 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	SOLHEIM SENIOR COMMUNITY		FACILITY NUMBER:	191802082
ADMINISTRATOR:	CHO MAUNG		FACILITY TYPE:	741
ADDRESS:	2236 MERTON AVENUE		TELEPHONE:	(323) 257-7518
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90041
CAPACITY:	126	CENSUS: 33	DATE:	06/15/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Meg Pierce		TIME COMPLETED:	12:15 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) Martina Berry conducted a Required Annual visit at the facility. The LPA met with Administrator Meg Pierce and Wellness Director Marie Garnett to conduct the entrance interview and explain the reason for the visit. The LPA started the facility tour at 10:15 AM. The facility currently has 33 residents. All Residents and staff were fully vaccinated as of March 2021. New residents are vaccinated prior to moving in or immediately afterward. New staff are required to test negative for COVID-19 prior to their start date. Vaccination is also offered for new staff. The facility currently has no active cases of COVID-19. Staff are tested monthly. N95 fit testing was completed in November 2020. The LPA toured all areas of the facility including, but not limited to common areas, bathrooms, activity room, kitchen, medication rooms, and visitation areas. COVID-19 and infection control signage is posted throughout the facility. Hand sanitizing stations are located throughout the facility. Restrooms are fully stocked with soap and hand washing supplies. Meals are offered in the facility's dining room or resident rooms by request. Meal times are staggered and the dining area is sanitized in between groups. Dining room maximum occupancy has been reduced to implement social distancing procedures. The LPA reviewed the facility's infection control plan. The facility is sanitized during each shift. Common areas are cleaned at least every 2 hours. Resident rooms are sanitized biweekly or as needed. Residents are screened at least every shift for COVID-19 symptoms. More frequent monitoring is implemented for at-risk residents. The facility keeps at least 30 days supply of medication for each resident. Residents and staff are required to wear PPE. PPE inventory is completed weekly. Residents that test positive for COVID-19 are isolated in a private room with designated staff to complete regular monitoring. Isolation bins with PPE supplies are made available for each isolation room. Staff that care for COVID-19 residents are assigned separate break times from Non-COVID staff.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (8185964342
LICENSING EVALUATOR NAME: Martina Berry	TELEPHONE: (661) 361-6007
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SOLHEIM SENIOR COMMUNITY	FACILITY NUMBER: 191802082
	VISIT DATE: 06/15/2021

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Visitors are allowed indoors and outdoors at the facility. The facility has designated visiting areas that residents are able to reserve for visits. Fully vaccinated residents may have in-room visits. Residents are provided with infection control updates during resident council meetings. Information updates are also posted for residents to review. Infection control updates are provided to staff during monthly staff meetings. Topics include review of Provider Information Notices (PINs), hand washing procedures, PPE requirements, and return to work policies.

No deficiencies cited. An exit interview was completed with Administrator Meg Pierce and Wellness Director Marie Garnett. A copy of this report was provided via email.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (8185964342
LICENSING EVALUATOR NAME: Martina Berry	TELEPHONE: (661) 361-6007
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021

LIC809 (FAS) - (06/04)

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