197609050-10-6-2021-11-AS-TAGD-C7JTG3-20211006144228

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609050
Report Date: 10/06/2021
Date Signed: 10/06/2021 02:43:56 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	TERRAZA OF CHEVIOT HILLS		FACILITY NUMBER:	197609050
ADMINISTRATOR:	JOEY ALVARADO		FACILITY TYPE:	740
ADDRESS:	3340 SHELBY DR		TELEPHONE:	(310) 837-9181
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90034
CAPACITY:	100	CENSUS: 54	DATE:	10/06/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:07 AM
MET WITH:	Business Office Manager, Sharette Smith		TIME COMPLETED:	12:00 PM

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On 10/06/2021 at 10:07a, Licensing Program Analyst (LPA) Troy Agard conducted an unannounced required annual visit with a primary focus on Infection Control measures using the new CARE Inspection Tools. Upon arrival at the facility, LPA Agard conducted a risk assessment at the facility’s front entrance. Based on the assessment, the facility is clear of Covid-19 infection. LPA was properly screened for Covid-19 symptoms and temperature was checked. LPA verified that the facility has an approved mitigation plan on file.

LPA met with the Business Office Manager, Sharette Smith and they both toured the inside and outside grounds of the facility. The following was toured in the two-story building: the main lobby, theater room, activity room, dining and kitchen area, laundry area, medication room and open courtyard area. Both floors have residents’ bedrooms that includes private and semi-private resident bedrooms and resident bathrooms. The facility is licensed to serve 100 Non-Ambulatory residents ages 60 and above and a Hospice waiver for 10 residents.

During the tour, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance; visitors log with Covid-19 screening and temperature log, and records of daily Covid-19 screening and temperature checks. PPE supplies are readily available to staff, and an additional supply of PPE is stored in one of the vacant rooms; sufficient paper, cleaning, and disinfecting supplies were observed. The facility’s designated visitation area is the back patio, in addition to the resident’s bedroom. LPA observed staff, residents, and visitors maintain 6 feet physical distancing, and each person wears a face covering. LPA observed required some posting throughout the facility.

The facility still conducts surveillance testing, once per week. Facility also completed N-95 fit testing for the staff. LPA did not observe any potentially dangerous items, including sanitizers, are kept inaccessible to residents.

Continued on 809C

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: TERRAZA OF CHEVIOT HILLS	FACILITY NUMBER: 197609050
	VISIT DATE: 10/06/2021

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A few rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed.

Furniture throughout the facility was in good repair, some marked or separated, and 6 feet apart from each other. There are no security bars or weapons on the premises. Resident bathrooms were checked, sufficient liquid soap and paper towels were observed. Toilets and water faucets worked properly, grab bars were secure, the shower was free of mold/mildew, and a non-skid mat was in place. The water temperature measured at 110 F. A comfortable temperature was maintained in the facility.

LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were kept in a locked storage cabinet. Centrally stored medications were observed stored in their originally received containers and kept safe, locked and inaccessible to clients in care. The First Aid kit was available. Several fire extinguishers were observed in the hallway throughout the facility.

Outside grounds were toured, and no bodies of water were observed. Walkways around the facility were clear of hazards. Common areas were clean and clear of hazards; doorways were free of obstructions.

No deficiencies were cited during this visit.

No Advisory Notes were issued, and no Technical Assistance was provided.

An exit interview was conducted, and a copy of this report was provided to Business Office Manager, Sharette Smith and a copy to Administrator.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021

LIC809 (FAS) - (06/04)

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