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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609105
Report Date: 09/01/2022
Date Signed: 09/01/2022 03:48:33 PM


Document Has Been Signed on 09/01/2022 03:48 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:GRANDVIEW, THEFACILITY NUMBER:
197609105
ADMINISTRATOR:FLORES, YENIFACILITY TYPE:
740
ADDRESS:2211 W 6TH STREETTELEPHONE:
(213) 380-7000
CITY:LOS ANGELESSTATE: CAZIP CODE:
90057
CAPACITY:215CENSUS: 158DATE:
09/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Yeni FloresTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPAs) LaQueena Lacy, Gary Tan and Associate Governmental Program Analyst (AGPAs) Daniel Pacheco and Michael Moriel arrived at the facility at 9:30am to conduct a One (1) year Required Infection Control visit. LPAs and AGPAs meet with the administrator Yeni Flores and explained the purpose of this visit.
A tour of the physical plant was conducted at 10:13am and the following was observed:

The facility has one main entrance being used, there are required Covid-19 prevention signage (hand washing, coughing etiquette, and physical distancing) posted and hand sanitizers wall mounted throughout the facility. The PPE screening station is located in the administration front desk office equipped with sufficient PPE readily accessible a thermometer, hand sanitizer, gloves, mask, and sign in sheet at the time of visit. Fire Extinguishers located throughout the facility first, second and third floor all serviced dated May 6, 2022. The facility has multiple first aid kits with manuals throughout the facility (medication room, administration office, kitchen common areas, etc.).
The facility has an approved mitigation plan on file.

Medication: At 10:18am observed to be inaccessible to residents in care, storing medication in clear bins, refrigerator, and medication carts. Medication is prepared for residents and then placed in medication carts observed to be locked until distribution in the front office inaccessible to residents.

Kitchen: At 10: 27am the kitchen was observed to be clean and an adequate supply of perishables and non-perishable food located in the fridge, freezer, and pantry. Food was properly labeled and stored. The emergency food is stored and observed to locked in a room labeled "Emergency Plan" across from the elevator and sprinkler valve room. Trash cans observed with lids. Lunch is staggered and served in individual plastic bags to maintain social distancing, lunch may be taken on the go or seated in the dining room. Sharps are stored in the kitchen inaccessible to residents.
Continued on LIC9099C.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena LacyTELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:
DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2022
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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GRANDVIEW, THE
FACILITY NUMBER: 197609105
VISIT DATE: 09/01/2022
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Storage Rooms: LPAs and AGPAs observed multiple locked storage rooms throughout the facility at 10:39am to be storing PPE, facility toiletries, incontinent supplies, linens wrapped in plastic protective covering, wash and dry towels, toxins, trash bags, laundry soap, bleach, other cleaning supplies and paper good items. The storage rooms located in the activity room is storing

Client Bedrooms: At 10:53am LPAs and AGPAs observed random rooms with bathrooms located inside on the first and second floor to be appropriately furnished with sufficient lighting. LPAs and AGPAs observed appropriately bed linen and comforters on all beds. Bedrooms contain single and double occupancy. All bedrooms observed to be clean and clear from obstruction. The water temperature measured at 105.7 between 132.6 degrees Fahrenheit. LPAs and AGPAs observed appropriate grab bars in shower and toilet area. Bathrooms are stocked and equipped with soap and paper towels. Hand towels are not shared.
Laundry Room: LPAs and AGPAs observed two (02) laundry rooms located on the lower level at 11:14am to be clean and clear from obstruction. Residents are allowed to do their own laundry if they choose, the industrial laundry machines were observed to be locked and used by staff, all laundry soap is locked in storage and is given by staff from the locked storage room if needed.
Living, dining room and common areas: LPAs and AGPAs observed at 11:21am to have sufficient tables and chairs for seating. Social distancing mark on floor. Outside and surrounding area of the facility observed to be clean and clear from debris and obstruction. At 11:33am the fire alarm system was observed to be tested by Los Angeles Fire Department on 05/19/2022 and 06/29/2022 to be working and operational, it is hard wired equipped with a water sprinkler system and a smoke detector test conducted by the facility dated 8/23/2022.
Record Review: At 12:45pm until 2:30pm LPAs reviewed sixteen (16) or ten (10%) percent of randomly selected resident files and nine (09) staff files. All required documents are present in resident and staff files.

Deficiency cited, exit interview conducted. Copy of appeal rights and report issued.

SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena LacyTELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 09/01/2022 03:48 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364


FACILITY NAME: GRANDVIEW, THE
FACILITY NUMBER: 197609105

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/01/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87303(e)(3)
Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows: (3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs' observation, the licensee did not comply with the section cited above due to the hot water temperature ranging from 105.7 to 132.6 degrees Fahrenheit, which poses an immediate health, safety or personal rights risk to persons in care
POC Due Date: 09/02/2022
Plan of Correction
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Licensee will provide LPA with proof of an immediate adjustment of the water temperature by POC due date, and submit a morning and afternoon water temperature tracking log of random rooms on both floors for one week beginning on 09/01/2022.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena LacyTELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:
DATE: 09/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2022
LIC809 (FAS) - (06/04)
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