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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197602106
Report Date: 06/28/2023
Date Signed: 06/28/2023 03:56:37 PM


Document Has Been Signed on 06/28/2023 03:56 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:BEVERLY HILLS CARMEL RETIREMENT HOTELFACILITY NUMBER:
197602106
ADMINISTRATOR:JOY ALVARADOFACILITY TYPE:
740
ADDRESS:8750 BURTON WAYTELEPHONE:
(310) 278-9720
CITY:LOS ANGELESSTATE: CAZIP CODE:
90048
CAPACITY:200CENSUS: 55DATE:
06/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:ADMINISTRATOR, Bernice PulancoTIME COMPLETED:
04:00 PM
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On 06/28/2023 Licensing Program Analyst (LPA) David España conducted an unannounced Annual visit. LPA was met by Boris Tamasi, Business Manager and later met by Administrator, Bernice Pulanco, and the purpose of today’s visit was explained.

Currently there are 55 residents, 7 are ambulatory and 48 of are non-ambulatory.

Structure/Physical Plant The facility is a 4-story building structure located in a residential neighborhood. It consists of (37) bedrooms, (47) bathrooms, lobby floor contains: front desk, office, tearoom, activity room, dining room, living room, TV room, laundry room, kitchen/ food storage, 2 elevators, and common restrooms. The 1st residential floor contains arts/crafts room, beauty shop, medication room, 2 storage rooms, janitor closet, 1 linen closet, outside seating patio with chairs and umbrellas, and common restrooms. The 2nd floor residential floor contains common restrooms, synagogue, janitor closet, PPEs storage room # 214, linen closet, and janitor's closet. The 3rd floor residential floor contains common restroom, library, janitor closet, 1 storage closet, and 1 linen closet. The front of the building is landscaped and there is a basement garage.

Rooms/Apartments LPA and Bernice toured the kitchen, first floor and second floor. LPA tour inside and out grounds with Boris Tamasi, Business Manager. Three to four rooms were toured on each floor. All the rooms toured were occupied by residents. Each room had the required furniture, including a bed, chair/couch, dresser, nightstand, lamp and ample closet space. Residents have the option to furnish rooms with their own belongings or keep the furnishings that is in there.

LPA did not observe any deficiencies; therefore, no citations were issued at this time. Due to time constraints a subsequent visit is required. An exit interview was conducted with Bernice Pulanco, Administrator and copy of report provided.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2023
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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