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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608371
Report Date: 02/07/2024
Date Signed: 02/07/2024 08:58:43 PM


Document Has Been Signed on 02/07/2024 08:58 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:SUMMERWIND MANOR VIIFACILITY NUMBER:
197608371
ADMINISTRATOR:JOSEPH SOLFACILITY TYPE:
740
ADDRESS:1308 ELM AVENUETELEPHONE:
(310) 328-3620
CITY:TORRANCESTATE: CAZIP CODE:
90503
CAPACITY:6CENSUS: 5DATE:
02/07/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:33 PM
MET WITH:Jemimah Mejia TIME COMPLETED:
04:04 PM
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On 02/07/24, Licensing Program Analysts (LPA) Ernand Dabuet conducted an unannounced Case Management visit at this facility. Upon arrival, LPA conducted a risk assessment. LPA spoke with administrator Joseph Sol who confirmed the facility has no COVID activity. LPA explained the purpose of the visit is to conduct a health and safety inspection.

On 01/29/24, the El Segundo Adult and Senior Care Regional Office received a call for a closure of Summerwind Manor VII set for 03/31/24. LPA conducted a health and safety check with residents. LPA observed five elderly residents in their rooms. Two of the residents were asleep and three were alert and were able have a brief conservation with LPA Dabuet. Room #1 and #5 are hospice residents. Administrator Joseph Sol had already given all family representatives oral notification of the closure. According to administrator Sol, (3) out of (5) residents have selected licensed facilities to relocate in Carson and Torrance areas.

LPA toured the physical plant. There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were stocked during the visit. Bathrooms were operational with running hot and cold water. LPA observed all utilities were in order.

LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. A review of Medication Records Administration (MAR) and Daily Monitoring of Vital Signs Log was observed to be maintained in order and accurately. A working landline telephone was available and operable. Smoke detectors and Fire Extinguishers were operational.

An exit interview conducted with Jemimah Mejia, and a copy of the report is provided.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
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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