191802082-7-23-2024-31-AS-HRAI-D7FT8U-20240723143056

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191802082
Report Date: 07/23/2024
Date Signed: 07/23/2024 02:32:02 PM

Document Has Been Signed on 07/23/2024 02:32 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	SOLHEIM SENIOR COMMUNITY		FACILITY NUMBER:	191802082
ADMINISTRATOR:	MEG PIERCE		FACILITY TYPE:	741
ADDRESS:	2236 MERTON AVENUE		TELEPHONE:	(323) 257-7518
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90041
CAPACITY:	126	CENSUS: 82	DATE:	07/23/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Meg Pierce, Administrator		TIME COMPLETED:	03:10 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	At 9:45 AM, Licensing Program Analyst (LPA), Huma Rahimi, conducted an unannounced annual inspection at the facility mentioned above. LPA met with the Administrator, Meg Pierce, and explained the reason for the visit. Physical tour was conducted with the Administrator and Maintenance Director and LPA observed the following: The facility is a two story building with private and shared bedrooms, private bathrooms, kitchen, dining room, recreation rooms, common areas, patios, and outdoor areas The facility has a Memory Care, Residential Assisted Living, and Skilled Nursing Unit. The facility has a fire clearance for one hundred and twenty-six (126) non-ambulatory clients, and a hospice waiver for seven (07). The facility has multiple fire extinguishers located throughout the facility to all have a service tag dated 01/01/2024. The smoke detectors are tested monthly and based on the LPA observations of the monthly inspection reports that shows results as passed for all apartments. The facility is equipped with fire sprinklers. Elevator: The facility had one functioning elevator. LPA observed a posting for the facility’s emergency evacuation routes which was clearly labeled. Kitchen: At 10:10 AM, LPA observed the kitchen to be clean and free from obstruction and inaccessible to residents. Appliances observed to be in good repair and functioning. The facility has a sufficient 7 days perishable and 2 days non-perishable food. The refrigerator (fresh fruit, vegetables, milk, bread, eggs, etc.) and the freezer (variety of meats, sandwich meat, desserts, and other dairy items) observed to be stocked and all properly labeled and stored. At 10:15 AM, LPA observed a two (02) rooms located near the entrance of the kitchen, one (01) to be storing a sufficient quantity of emergency food, the second to be storing brooms, mop buckets and cleaning supplies. Continue on LIC 809C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024

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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SOLHEIM SENIOR COMMUNITY	FACILITY NUMBER: 191802082
	VISIT DATE: 07/23/2024

NARRATIVE

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Bedrooms: At 10:20 AM, LPA observed fourteen (14) random bedrooms that are equipped with private bathrooms. All bedrooms observed to be appropriately furnished with sufficient lighting. LPA observed appropriately bed linen and comforters on all beds. All bedrooms observed to be clean and clear from obstruction are single occupancy. The facility has public bathrooms located throughout the facility for visitors.
Bathrooms: At 10:20 AM, LPA observed fourteen (14) private resident’s bathrooms and an additional public bathroom to be clean and clear from obstruction. LPA observed appropriate grab bars in shower and toilet area or a commode with handles around the toilet area. Bathrooms are stocked and equipped with soap and paper towels. At 10:22 AM, the hot water temperature measured at 118.4 degrees Fahrenheit.
Medications: At 10:30 AM, LPA observed two (02) nursing stations on the first floor in the memory care unit, and on the second floor in the resident assisted living unit, to be storing medication carts, first aid kit with manuals, and resident records. Medication carts, refrigerators used for medication and specimen collection were observed to be locked and inaccessible to residents. LPA observed cupboards with medication baskets with resident names attached.
Living, dining room and common areas: The facility has three (3) patio areas for residents in care. At 10:35 AM, LPA observed the outdoor patio area for memory care and residential assisted living to have sufficient table and chairs for seating under a cover area. The facility has multiple dining areas throughout the facility that has a kitchenette area (counter, sink and refrigerator) inaccessible to residents. No toxins or hazardous materials stored in these areas. The facility has bookshelves located in the hallways in the facility accessible to residents for enjoyment. All common areas are appropriately furnished with tables and chairs and adequate lighting. LPA observed the areas to be clean and free from debris. At 10:40 AM, LPA observed a storage closet on the second floor near the elevator to be storing an emergency disaster kits, wheelchairs and extra linens and hand and bath towels. LPA also observed additional closets for extra linens.

Laundry Room: At 10:45 AM. LPA observed the laundry room located in the basement to be inaccessible to residents clean and clear from obstruction. Extra cleaning supplies, laundry detergents, and other items were stored in the basement/laundry room.

Continue on LIC 809C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: SOLHEIM SENIOR COMMUNITY	FACILITY NUMBER: 191802082
	VISIT DATE: 07/23/2024

NARRATIVE

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At 10:20 AM, LPA tested the call system in Room #215 to be functional. Staff responded to the call within thirty (30) seconds.

Between 1:00 PM to 2:30 PM, LPA reviewed records of nine (9) resident and six (6) staff. Resident and staff records appeared to be complete and updated.

No deficiencies cited, exit interview conducted, copy of report signed and issued.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Huma Rahimi	TELEPHONE: (818) 304-2399
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024

LIC809 (FAS) - (06/04)

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