197602106-6-25-2021-11-AS-ASOO-C4AR2N-20210624123838

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197602106
Report Date: 06/24/2021
Date Signed: 06/25/2021 11:19:39 AM

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:	BEVERLY HILLS CARMEL RETIREMENT HOTEL		FACILITY NUMBER:	197602106
ADMINISTRATOR:	JOY ALVARADO		FACILITY TYPE:	740
ADDRESS:	8750 BURTON WAY		TELEPHONE:	(310) 278-9720
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90048
CAPACITY:	200	CENSUS: 51	DATE:	06/24/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Bernice Pulanco, Administrator		TIME COMPLETED:	12:30 PM

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Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual required / infection control visit to the above facility. LPA was met by Bernice Pulanco, administrator and the purpose of today’s visit was explained.

There are currently (51) residents in the facility. (6) residents are ambulatory and (45) are non-ambulatory. The facility is a 4 story building structure located in a residential neighborhood. It consists (37) bedrooms, (47) bathrooms, lobby floor contains: front desk, office, tea room, activity room, dining room, living room, TV room, laundry room, kitchen/ food storage, tea room,2 elevators, and common restrooms. 1st residential floor contains: arts/crafts room, beauty shop, medication room, 2 storage rooms, janitor closet, 1 linen closet, and common restrooms. 2 floor residential floor contains: common restrooms, synagogue, janitor closet, PPEs storage room # 214, linen closet, janitor's closet, and staff lounge. 3rd floor residential floor contains: common restroom, library, janitor closet, 1 storage closet, and 1 linen closet. Front building landscape and basement garage.

LPA and Bernice toured the entire facility inside and out. Documents are posted as mandated. 51 are occupied by residents and contain the mandated furniture. The (47) bathrooms are clean and operational. First aid kit is fully stocked with manual, smoke detectors are hard wired with the Fire Department and carbon monoxide detector in each of the residential floor were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored and locked in the medication room on the 2nd floor and are inaccessible to residents . 5 Residents files were current along with their medication. 5 Staff file are current. Ample supply of perishable and nonperishable food, hot water temperature is 118 degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, 8 fire extinguisher are fully charged, fire drill conducted on 04/2021. First Aid kit complete and with Manual. Exit, walkways and/or passageways are free of debris and/or hazards. The facility is in good repair.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021

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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: BEVERLY HILLS CARMEL RETIREMENT HOTEL	FACILITY NUMBER: 197602106
	VISIT DATE: 06/24/2021

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During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry, visitors temperatures are checked and logged, sanitizer/soap throughout the facility and additional sanitation supplies are locked in room 214. LPA observed staff and residents wearing masks, resident private rooms will be converted to isolation rooms (if needed) and required postings throughout the facility. The residents temperature's are checked and logged once a day. PPE's are enough for 30 days.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time.

An exit interview conducted with Bernice Pulanco, Administrator and copy of report provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021

LIC809 (FAS) - (06/04)

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