197608376-2-24-2023-11-AS-WGIS-CPCVBC-20230224151718

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608376
Report Date: 02/24/2023
Date Signed: 02/24/2023 03:17:24 PM

Document Has Been Signed on 02/24/2023 03:17 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	REDONDO BEACH ELDERLY HOME		FACILITY NUMBER:	197608376
ADMINISTRATOR:	RHODA MABUTAS		FACILITY TYPE:	740
ADDRESS:	18312 MANSEL AVENUE		TELEPHONE:	(310) 371-7193
CITY:	REDONDO BEACH	STATE: CA	ZIP CODE:	90278
CAPACITY: 12		CENSUS: 11	DATE:	02/24/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:34 PM
MET WITH:	Marlita Vigo		TIME COMPLETED:	03:30 PM

NARRATIVE

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Licensing Program Analyst (LPA's) Wendy Gibbs conducted an unannounced Annual required visit with the primary focus on Infection Control. LPA met with Ley (Merlita) Vigo and explained the purpose of todays visit. Currently there are 11 residents residing in the facility. There are 5 ambulatory residents and 6 non-ambulatory residents.

Structure The facility is a single-story structure located in a residential neighborhood. The facility consists of (9) bedrooms, (3) full bathrooms and (2) half baths shaded front and side yard, laundry room in the attached 2 car garage.

Physical Plant LPA and Ley toured the facility. There is a shaded seating area in the front for residents. There are ramps on both the north and south side of the facility. There is a side yard for outside activities. LPA did not observe any bodies of water on the premises. All walkways were clean, clear, and free of obstructions, hazards or debris.

Bedrooms LPA inspected all resident bedrooms. LPA observed all bedrooms had the required furniture including bed(s), dresser(s), nightstand(s), chair(s), and ample storage space for personal belongings. All beds had the required linens including mattress cover, fitted sheets, blankets, comforter and pillow. LPA observed an ample supply of linens and blankets.

Bathrooms LPA inspected all bathrooms and found them to be clean and fully functioning. All bathrooms had ample supply of hand soap and paper towels. Bathrooms with showers were observed to have shower chairs and nonskid mats. All safety hand rails were secured. LPA observed storage for resident’s toiletries. Water temperature measured between 117.2-degrees to 118.9-degrees Fahrenheit.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023

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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: REDONDO BEACH ELDERLY HOME	FACILITY NUMBER: 197608376
	VISIT DATE: 02/24/2023

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Kitchen LPA inspected the kitchen and found it to be clean and operable. All appliances were in good working repair. LPA observed an ample supply of cutleries, pots and pans in good repair. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods. All sharps are locked in a drawer and inaccessible to residents. All cleaning supplies are securely stored and inaccessible to residents. Common Areas LPA inspected the living room and dining room. LPA observed ample seating in the living room to accommodate all residents. LPA observed tables and ample seating for residents in the dining room. LPA observed activities, puzzles, books and games, stored in the living room. All rooms had ample lighting. All walkways were clean, clear and free of obstructions or hazards. A comfortable temperature was maintained in the facility. LPA observed the facility to be in good repair.
Safety LPA observed 3 fully charged fire extinguisher mounted throughout the facility last serviced on 08/30/22. The last emergency drill was on 02/19/23. The facility has a sprinkler system which was last serviced on 01/24/23. All smoke detectors and carbon monoxide detectors were tested and fully operable. All exits are clearly marked. All required posting were observed. All rooms where oxygen was in use were clearly marked with no smoking signs oxygen in use. The facility had a working landline. No firearms are ammunition are kept on the premises. LPA observed a fully stocked First Aid Kit with all the required items and a manual.
Infection Control During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry, visitors are logged, and temperature checked. LPA observed all staff wearing face covering. Additional sanitation supplies are locked in the garage. Resident’s temperature is taken daily. LPA observed required infection control posting throughout the facility. LPA observed a 30-day supply of PPE stored in the garage.
Files LPA reviewed 4 resident files and found they contained the required documents. LPA reviewed 2 staff files and found they contained the required documents, training and certification.
Medications LPA reviewed the medications and MARs for 4 resident and found the to be current. Medications are stored in a locked cabinet in the kitchen and were inaccessible to residents.

LPA reviewed the facilities Liability Insurance through Acord, which expires on 11/01/23.

LPA did not observe any deficiencies during todays visit.

An exit interview was conducted with Ley Vigo, and copy of this report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023

LIC809 (FAS) - (06/04)

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