197607582-10-17-2023-11-AS-MLEN-CWQ23U-20231017170256

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607582
Report Date: 10/17/2023
Date Signed: 10/17/2023 05:05:33 PM

Document Has Been Signed on 10/17/2023 05:05 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	PALM GARDENS WELLNESS HOME		FACILITY NUMBER:	197607582
ADMINISTRATOR:	DARYLLEN STONE		FACILITY TYPE:	740
ADDRESS:	5651 WALTON STREET		TELEPHONE:	(562) 421-5577
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90815
CAPACITY:	6	CENSUS: 6	DATE:	10/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Anchie Reyes, Assistant Administrator		TIME COMPLETED:	02:41 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	On 10/17/23, Licensing Program Analyst (LPA) Mario Leon conducted an unannounced annual required visit using the CARE inspection tool. LPA was met by Anchie Reyes, Assistant Administrator, and explained the purpose of the visit. The facility is a single-story structure located in a residential neighborhood. It consists of the following: five (5) resident's rooms, two (2) common bathrooms, living area, dining area, kitchen, a staff room and outside covered patio area. LPA toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be clean and operational. The water temperature measured 114.4 degrees F in bathroom #1 and 114.2 degrees F in bathroom #2. A comfortable temperature of 72.2 degrees F was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available and maintained properly. Smoke detectors and two carbon monoxide detectors were working properly. The facility has two (2) fire extinguishers that were charged, last checked as of 07/17/2023. A working mobile telephone remains available, on-site, as 562-519-9091. Toxins and sharps were locked and inaccessible to clients. Medications were locked and inaccessible to clients and centrally stored, first aid kit was checked and needed new bandages. Outside grounds were toured and no bodies of water were observed. Shaded area in backyard was accessible. Exits/Walkways around the home were free of debris and hazards. Report Continues, see LIC809C

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario Leon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023

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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: PALM GARDENS WELLNESS HOME	FACILITY NUMBER: 197607582
	VISIT DATE: 10/17/2023

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During the visit, LPA Leon observed the facility infection control practices. LPA Leon observed screening protocols for visitors, hand sanitizer was available throughout the facility located on the walls and in the front entrance region.

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

During today's visit, there were no deficiencies cited.

An exit interview was held with Assistant Administrator, Anchie Reyes, and a copy of this report was provided.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario Leon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023

LIC809 (FAS) - (06/04)

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