197606651-6-18-2024-28-AS-VMAO-D65U3W-20240611151413

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197606651
Report Date: 06/11/2024
Date Signed: 06/18/2024 10:49:29 AM

Document Has Been Signed on 06/18/2024 10:49 AM - It Cannot Be Edited

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	LAKEWOOD GARDENS		FACILITY NUMBER:	197606651
ADMINISTRATOR:	MARIE JEENE R DE CASTRO		FACILITY TYPE:	740
ADDRESS:	12055 S. LAKEWOOD BLVD.		TELEPHONE:	(562) 869-4038
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY:	150	CENSUS: 85	DATE:	06/11/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Administrator Jeene		TIME COMPLETED:	03:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPA's) Tyler Reyes and Valeria Maldonado conducted an unannounced required annual inspection using the CARE tools. LPAs met with Administrator Jeene De Castro and explained the reason of the visit. The facility is an Residential Facility for the Elderly (RCFE) licensed to serve (150) non-ambulatory residents, ages 60 years and above. Hospice waiver was approved for for (27) residents. Administrator Jeene has an RCFE Certificate issued for 6/11/23 with an expiration date of 6/10/25 . LPA and Administrator Jeene toured the facility and the following was observed: the 2 outside patios are clean and there are shaded seating areas for the residents. Passageways and exits are free of obstruction. The water temperature was tested in the 3 residents’ bathrooms and 1 common bathroom and measured between at 112 and 118 degrees F, which is within the required 105 - 120 degrees F. The bathrooms are clean and have the required grab bars in the shower and near the toilet for non-ambulatory residents. Showers also have the required non-skid mats. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Resident beds have the required linen and the linen is in good condition. Smoke detectors were observed in each room and throughout the facility and are properly operating. There are multiple carbon monoxide detectors throughout the facility and are properly operating. There are multiple fire extinguishers throughout the facility, which are fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps are kept in the kitchen and are inaccessible to the residents. Cleaning supplies and toxins are kept in a locked storage. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. First Aid kit was fully stocked with current manual and it is kept in the medication room. Residents medication are centrally stored in the medication room. Residents and staff files are centrally stored in the administrator’s office. (CONTINUED TO LIC 809C)

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024

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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: LAKEWOOD GARDENS	FACILITY NUMBER: 197606651
	VISIT DATE: 06/11/2024

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LPA reviewed medication for six residents and observed that medications are documented properly and given as prescribed. LPA reviewed files for five residents and five staff and observed all required documentation on file.

Required signs are posted throughout the facility, and hand-washing signs were observed in bathroom. Sufficient hand soap, hand sanitizer, and paper towels were observed. Supply of 30-day Personal Protective Equipment (PPE) was observed in the storage room.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during today's visit.

Exit interview was conducted with Jeenne De Castro administrator and a copy of this report was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024

LIC809 (FAS) - (06/04)

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