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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603601
Report Date: 01/11/2022
Date Signed: 01/12/2022 09:28:42 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 LOVING CAREFACILITY NUMBER:
197603601
ADMINISTRATOR:LIDA ZARAFSHANFACILITY TYPE:
740
ADDRESS:1019 S. WOOSTER STREETTELEPHONE:
(310) 652-3555
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY:176CENSUS: 75DATE:
01/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Lida ZarafshanTIME COMPLETED:
01:50 PM
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Licensing Program Analysts (LPA) Martessa Brown and Gail Johnson conducted an unannounced Annual required visit with a primary focus on infection control measures. LPAs was met by Administrator, Linda Zarafshan and the purpose of today’s visit was explained. The facility is an Elderly Residential licensed to serve 176. 60 years and older which may include 64 Non-Ambulatory and 5 Bedridden in Rooms # 104, 106,108,118 and 128.

The facility is a three-story structure located in a residential neighborhood. It consists of the following: 175 bedrooms with bathrooms located in each room, 2 main bathrooms, 2 dining rooms, 2 kitchens, Tv rooms, outside shaded area and laundry room.

LPA and staff toured the physical plant. There are no bodies of water or firearm/ammunition on the premises. Checked residents rooms were checked. Beds and bedding were in good condition, adequate lighting provided. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured in restroom #1 116.8 and #2 staff restroom was at 125 F.1 F. The facility is a comfortable temperature is maintained in the facility. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for cleaning agents, toxins, and sharps are inaccessible to residents. The kitchen was inspected and there is a enough perishable and non-perishable food available which is stored properly. Fire extinguisher was charged, smoke detectors and Carbon Monoxide were operable.

During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff and residents, sanitizing stations (Located in common areas and restrooms). LPA observed staff and residents were wearing face coverings, an isolation room and required postings throughout the facility. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE).

LPA advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Likening Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance.

During today’s visit there were no deficiencies observed.

Exit interview held. A copy of the report was provided to Administrator, Linda Zarafshan.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Martessa BrownTELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2022
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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