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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608888
Report Date: 08/02/2023
Date Signed: 08/02/2023 03:04:41 PM


Document Has Been Signed on 08/02/2023 03:04 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:WEST PICO TERRACE ASSISTED LIVING CENTER LPFACILITY NUMBER:
197608888
ADMINISTRATOR:CHRISTOPHER,MELISSAFACILITY TYPE:
740
ADDRESS:6050 W PICO BLVDTELEPHONE:
(323) 653-5565
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY:136CENSUS: 70DATE:
08/02/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:12 PM
MET WITH:Robin Owens-Resident DirectorTIME COMPLETED:
03:04 PM
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On 8/2/2023 Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced Case Management visit. Upon arriving at the facility, LPA met with Robin Owens/Resident Director who assisted with the visit. LPA explained the purpose of today's visit is to check on the Plan of Correction cited on 7/26/2023.

At 2:00 PM, LPA and Resident Director tour the facility and inspected the rooms where the AC was not working during the previous visit on 7/26/23. The rooms are: 212, 211, 210, 215, 309 and 307. LPA checked the AC vents and cool air was blowing from them, also the overall temperature in all rooms was 75.4F°. in addition, LPA got a copy of the receipt given by the AC repair company, the date marked on the receipt is 7/31/2023.

LPA cleared citations rendered on 7/26/2023.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe 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 Robin Owens/Resident Director.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2023
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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