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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607802
Report Date: 09/16/2023
Date Signed: 09/18/2023 08:02:50 AM


Document Has Been Signed on 09/18/2023 08:02 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:BETTER LIVING & CARE IIIFACILITY NUMBER:
197607802
ADMINISTRATOR:LUCIEN EZROSFACILITY TYPE:
740
ADDRESS:624 N. HARPER AVENUETELEPHONE:
(323) 424-7052
CITY:LOS ANGELESSTATE: CAZIP CODE:
90048
CAPACITY:6CENSUS: 3DATE:
09/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:42 AM
MET WITH:STAFF VIOLETTA KHALILOVATIME COMPLETED:
12:00 PM
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On 09/16/2023 at 09:45 AM, Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced annual inspection visit at the Better Living & Care 3 Facility. LPA Calderon was allowed entry into the facility by Staff Violetta Khalilova. Staff Violetta Khalilova asked infection control questions and took LPA Calderon temperature prior to entrance into the facility. The facility is licensed for six (6) adult clients with developmental disabilities. Currently, there are three (3) residents residing in the facility with developmental disabilities.

LPA Calderon explained to Staff Violetta Khalilova, the purpose of the one-year Annual Inspection visit, and escorted LPA Calderon on a tour of the entire inside and outside facility grounds. As part of the inspection, LPA Calderon reviewed: (PENDING) three (3) resident service records, (PENDING) three (3) resident medication records, (PENDING) two (2) staff records, and inspected the inside facility and outside grounds. The facilities’ last fire drill was conducted on (PENDING). The one-story residential home consists of three (3) resident bedrooms, two (2) resident bathrooms, living room, dining room, family room, kitchen, office area, washer and dryer/ storage area, backyard with table and chairs. No weapons are stored in the premises. Kitchen was inspected and observed to be clean and operational. A two-day supply perishable and seven-day supply of non-perishable foods are present in the facility. Emergency Water supply is found in the garage area.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2023
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: BETTER LIVING & CARE III
FACILITY NUMBER: 197607802
VISIT DATE: 09/16/2023
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LPA Calderon observed that all facility rooms are clean and in good repair. A comfortable temperature was observed, and the facility has central air and heating. LPA Calderon observed the following during inspection of resident’s rooms: mattresses are in good condition, adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. All bedrooms contain furniture, lighting fixtures and personal storage space as required, all beds have the required amount of linen and mattress covers, LPA Calderon observed fully stocked closet with bedding, towels, and toiletries supplies. Bathroom fixtures are clean, in good repair, and working properly and contain the required nonskid mats and grab bars. LPA Calderon observed bathrooms were found to be within Title 22 regulation. Bathroom #1 hot water temperature properly measured at 111 degrees Fahrenheit, and bathroom #2 hot water temperature properly measured at 111 degrees Fahrenheit. Kitchen hot water temperature properly measured at 110 degrees Fahrenheit. Facility two (2) carbon Monoxide and seven (7) Smoke Detectors hard wired and connected were tested and are working properly. The facility three (3) Fire Extinguishers were checked and found to be fully charged and accessible. All exit doors in the facility have alarm systems. All toxins and knifes are locked/secured and inaccessible to residents. Medications are centrally stored and in a locked storage cabinet. Facility first aid kit is fully stocked with manual was checked and in order. Outside grounds were toured and no bodies of water were observed. All Exits/ Walkways around the home were free of debris and hazards. Outside patio accessible to residents. (PENDING) Three (3) resident files were reviewed and found to be complete. LPA Calderon reviewed (PENDING) three (3) resident medications and they were all found to be administered according to doctor's orders. (PENDING) Two (2) staff files were checked and have the required documents. LPA Calderon noted the Administrator Lucien Ezros Certification # PENDING expiration date of 00/00/2024 was UNCLEAR valid at time of visit. The facility does NOT handle resident's money/cash resources and a NO Surety bond is needed. General Lability Policy #PENDING policy period from 00/00/2023 to 00/00/2024 underwritten by PENDING Insurance Company Inc, coverage 1,000,000/3,000,000 is PENDING valid at time of inspection. LPA Calderon spoke to Administrator Lucien Ezros who will email valid insurance contact to LPA Calderon on 10/09/2023. All the required documents are posted in the facility in a clearly visible area. LPA Calderon reviewed LIC500 and noted all staff associated to facility.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2023
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: BETTER LIVING & CARE III
FACILITY NUMBER: 197607802
VISIT DATE: 09/16/2023
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During the visit, LPA Calderon observed the facility infection control practices. LPA Calderon observed screening protocols for visitors, staff, and residents, sanitizing stations (Located in common areas and restrooms). LPA Calderon observed staff and residents were NOT wearing face coverings and required postings throughout the facility. LPA Calderon observed the facility has a thirty-day supply of Personal Protective Equipment (PPE).

LPA Calderon advised the Staff Violetta Khalilova 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.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA Calderon did not observe any deficiencies therefore NO citations were issued at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Staff Violetta Khalilova.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2023
LIC809 (FAS) - (06/04)
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