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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197602370
Report Date: 07/30/2021
Date Signed: 08/02/2021 09:34:10 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 NORTHFACILITY NUMBER:
197602370
ADMINISTRATOR:ARIELLA BENBASSATFACILITY TYPE:
740
ADDRESS:8757 BURTON WAYTELEPHONE:
(310) 278-8323
CITY:LOS ANGELESSTATE: CAZIP CODE:
90048
CAPACITY:138CENSUS: 40DATE:
07/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ariella BenBassat, AdministratorTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual required visit and an infection control inspection to the above facility. LPA was met by Nora Polanco, and later met with Ariella BenBassat, Administrator and the purpose of today’s visit was explained.

There are currently (40) residents in the facility. (19) residents are ambulatory and (22) are non-ambulatory. The facility is a 4-story structure located in a residential neighborhood. It consists (79) bedrooms, (8) common area bathrooms, (79) full private bathroom, shaded back yard, front yard, 1st Floor: Lobby, Receptionist desk, library, elevator activity room, storage, salon Administrators office, kitchen, laundry room, linen closet, PPE storage, 2nd Floor: patio, card room, janitor's closet, linen closet, 3rd Floor; linen closet, storage, janitor's closet, electrical closet, 4th Floor: janitor's closet and linen closet.

LPA and Ariella and Nora toured the entire facility inside and out. Documents are posted as mandated. Bedrooms are occupied by residents and contain the mandated furniture. Bedroom. The common area and resident's bathrooms are clean and operational. First aid kit completes with manual; smoke detectors and carbon monoxide detector were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. Ample supply of perishable and nonperishable food, hot water temperature is 111 degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, 6 fire extinguishers are fully charged, fire drill conducted on 04/2021. Exit, walkways and/or passageways, front yard and trash area are free of debris and/or hazards. The facility is in good repair. During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry, visitors are logged, and temperature checked, sanitizer/soap through out the facility. LPA observed staff and clients wearing masks, residents’ private rooms will be converted to isolation rooms (if needed) and required postings throughout the facility. The facility has an approved Mitigation plan. The resident’s temperatures are checked and logged once a day. PPE's are enough for 30 days.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021
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 NORTH
FACILITY NUMBER: 197602370
VISIT DATE: 07/30/2021
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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 Ariella BenBassat, Administrator and copy of report provided.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021
LIC809 (FAS) - (06/04)
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