197603601-2-7-2024-11-AS-EGOZ-D28U2Z-20240207141245

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197603601
Report Date: 02/07/2024
Date Signed: 02/07/2024 02:13:00 PM

Document Has Been Signed on 02/07/2024 02:13 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:	BEVERLY HILLS LOVING CARE		FACILITY NUMBER:	197603601
ADMINISTRATOR:	LIDA ZARAFSHAN		FACILITY TYPE:	740
ADDRESS:	1019 S. WOOSTER STREET		TELEPHONE:	(310) 652-3555
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90035
CAPACITY:	176	CENSUS: 96	DATE:	02/07/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:58 AM
MET WITH:	Lida Zarafshan		TIME COMPLETED:	02:30 PM

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On 2/7/24 Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced annual required visit. LPA met with the facility’s administrator Lida Zarafshan and the purpose of today’s visit was explained. LPA was granted access to this facility. The facility is licensed to serve one hundred seventy-six (176) residents sixty-four (64) non-ambulatory and five (5) bedridden in rooms # 104, #106, #108, #118 and #128. There are currently eighty (80) residents in placement.

This facility consists of two buildings. Wooster Building consists of 50 bedrooms with private bathrooms, a dining room, kitchen, activity rooms, and an underground garage. Olympic Building consists of 62 bedrooms with private bathrooms, a dining room, kitchen, activity rooms and an underground garage.

LPA Gonzalez and administrator Lida Zarafshan toured the inside and outside grounds of the facility. As part of this inspection LPA checked rooms #105, #110, #111, #119 in Olympic building and rooms #103, #104, #109, #115 in Wooster building. All resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, the shower was free of mold/mildew and a non-skid mat was in place. The water temperature measured between 105.0 F and 120.0 F in all bathrooms. Extra linen, bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. LPA did not observe any bodies of water. A comfortable temperature was maintained in both buildings. LPA observed the facility to be clean and appropriately furnished at the time of visit.

The kitchen was checked and observed to be within Title 22 regulations. Sufficient perishable and non-perishable food supply was maintained adequately. All sharps, toxins, cleaning solutions, hazardous items, and medications were securely locked and inaccessible to clients.

Continued on LIC 809-C

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

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: BEVERLY HILLS LOVING CARE	FACILITY NUMBER: 197603601
	VISIT DATE: 02/07/2024

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The facility has a landline telephone on-site in working condition. Medications were centrally stored and properly locked. Smoke detectors and carbon monoxide detectors were operational and working properly. LPA observed a fully charged fire extinguishers. LPA observed a stocked First Aid kit along with manual locked and inaccessible to clients. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards.

During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff and residents, LPA observed sanitizing stations located in common areas and restrooms. LPA observed all the required postings throughout the facility. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). The facility has an approved CCLD Mitigation Plan.

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

An exit interview was conducted, and a copy of the Report and Appeal Rights was provided to administrator Lida Zarafshan.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

LIC809 (FAS) - (06/04)

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