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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197602106
Report Date: 06/14/2024
Date Signed: 06/14/2024 03:08:10 PM


Document Has Been Signed on 06/14/2024 03:08 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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245



FACILITY NAME:PINNACLES AT BURTON, THEFACILITY NUMBER:
197602106
ADMINISTRATOR:PULANCO, BERNICEFACILITY TYPE:
740
ADDRESS:8750 BURTON WAYTELEPHONE:
(310) 278-9720
CITY:LOS ANGELESSTATE: CAZIP CODE:
90048
CAPACITY:200CENSUS: 67DATE:
06/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
07:59 AM
MET WITH:Chanel Sanchez; AdministratorTIME COMPLETED:
03:30 PM
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On 06/14/24, Licensing Program Analyst (LPA), David España conducted an unannounced annual visit using the full CAREs tool. Upon arrival at the facility, LPA España conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection (No COVID-19 cases). LPA verified that the facility has an approved mitigation plan report. LPA was granted access and allowed to enter the facility to conduct the inspection. LPA was met by Chanel Sanchez; Administrator and the purpose of today’s visit was explained. Currently there are 62 residents, 11 are ambulatory and 51 of are non-ambulatory.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. LIC809 (cont)
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2024
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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: PINNACLES AT BURTON, THE
FACILITY NUMBER: 197602106
VISIT DATE: 06/14/2024
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The front of the building is landscaped and there is a basement garage. The last fire drill was conducted on 05/14/2024. LPA and Chanel Sanchez, Administrator toured the kitchen, first floor and second floor. LPA tour inside and out grounds with Chanel Sanchez, Administrator. Six rooms were toured at the time of visit. 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 the unit.

LPA did not observe any deficiencies; therefore, no citations were issued at this time.



An exit interview was conducted with Chanel Sanchez; Administrator and copy of report provided.
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024
LIC809 (FAS) - (06/04)
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