197608888-5-9-2024-11-AS-EGOZ-D54UBU-20240509152656

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608888
Report Date: 05/09/2024
Date Signed: 05/09/2024 03:27:07 PM

Document Has Been Signed on 05/09/2024 03:27 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:	WEST PICO TERRACE ASSISTED LIVING CENTER LP		FACILITY NUMBER:	197608888
ADMINISTRATOR:	CHRISTOPHER,MELISSA		FACILITY TYPE:	740
ADDRESS:	6050 W PICO BLVD		TELEPHONE:	(323) 653-5565
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90035
CAPACITY:	136	CENSUS: 83	DATE:	05/09/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:34 AM
MET WITH:	Azucena Reyes		TIME COMPLETED:	03:35 PM

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On 05/09/24 Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced Annual inspection visit to the above facility using the CARE tool. LPA was met by Azucena Reyes, Assistant Administrator, and the purpose of today’s visit was explained.The facility is licensed to serve one hundred thirty-six (136) adults aged 60 and over. The requested capacity is for one hundred thirty-six (136) non-ambulatory residents. Facility has a hospice waiver for thirty (30). Currently there are eighty three (83) residents in this facility.

The facility is a three story commercial building. The first floor consists of the parking structure, laundry room, maintenance office, administrative office, and a kitchen. Floors level two (2) and three (3) are occupied by residents. There are two activity rooms, and two outside shaded patios on the second floor. On the third floor there is a dining/activity room, and a medication room.

LPA Gonzalez and Azucena Reyes toured the physical plant inside and out. There were no bodies of water or obstructions on the premises. LPA and Administrator inspected bedrooms #201, #203, #207, #209 on the second floor, and bedrooms #307, #309, #314, #316 on the third floor. All bedrooms had the required furniture and in good condition, bed linens and closet/drawer space to accommodate each resident comfortably. The walls and floors within the facility were observed to be in good repair. Each bedroom inspected had their own bathrooms. LPA inspected the bathrooms and observed them to be clean and operational and found to be within Title 22 regulations. The water temperature properly measured between 105.0 F and 120.0 F. LPA observed the facility to be clean and appropriately furnished with clear passageways inside and outside. A comfortable temperature was maintained in the facility.

Continued on LIC809-C

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: WEST PICO TERRACE ASSISTED LIVING CENTER LP	FACILITY NUMBER: 197608888
	VISIT DATE: 05/09/2024

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The kitchen was inspected and there is sufficient perishable and non-perishable food supply and maintained adequately. Sharps, toxins, cleaning solutions, and hazardous items were securely locked and inaccessible to residents. Medications are kept on the third (3rd) floor in the Medication room. Exits/ Walkways around the facility were free of debris and hazards. Hard wired smoke detectors and carbon monoxide are working properly. All fire extinguishers throughout the facility were fully charged. A stocked First Aid kit along with manual was available. The facility has a landline telephone located in the office and hallway.

During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and clients. There are sanitizing stations in common areas and restrooms. All mandated inspection control posters were posted.

During this inspection LPA did not observe any deficiencies, therefore no citations were issued at this time.

An exit interview was conducted, and a copy of the report and Appeal Rights was provided to Administrator, Clarizze Punit.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

LIC809 (FAS) - (06/04)

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