197609594-2-22-2022-31-AS-RVAA-CBVVR4-20220222153920

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609594
Report Date: 02/17/2022
Date Signed: 02/22/2022 03:39:36 PM

Document Has Been Signed on 02/22/2022 03:39 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:	SPARR HEIGHTS ESTATES SENIOR LIVING		FACILITY NUMBER:	197609594
ADMINISTRATOR:	ERIKA HUGHES		FACILITY TYPE:	740
ADDRESS:	2640 HONOLULU AVE		TELEPHONE:	(818) 248-6737
CITY:	MONTROSE	STATE: CA	ZIP CODE:	91020
CAPACITY:	131	CENSUS: 55	DATE:	02/17/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Ernest Lewis, Executive Director		TIME COMPLETED:	04:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced Required 1 year infection control inspection to the facility. LPA met with Executive Director Ernest Lewis. The purpose of the visit was discussed. At 10:45am, with the assistance of the ED, LPA conducted a tour of the facility. There is one main entrance being utilized at the facility, there are required posters posted at the main door. Screening area is located immediately upon entrance. Temperature was checked, and a sign in sheet with Covid questions was available. LPA was screened upon entry. The facility had submitted and approved Mitigation Plan. Signs to wear a mask and other COVID-19 prevention protocol signs were posted outside the door. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated visitors' area in the front of the building. The facility has sufficient stock of PPE in the storage room. See 809-C to continue

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022

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: SPARR HEIGHTS ESTATES SENIOR LIVING	FACILITY NUMBER: 197609594
	VISIT DATE: 02/17/2022

NARRATIVE

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The facility consists of one main building. The Independent Living section of the facility is on the top floor and the Memory Care Unit is located on the bottom floor.

The facility has a capacity for 131 residents. Currently 55 rooms are being occupied. Common areas were checked for cleanliness. Food Service/Kitchen area was sufficiently stocked with two (2) days of perishable and seven (7) days of non-perishable food. The residents rooms are adequately furnished with appropriate furniture and lighting system.

The facility maintains a comfortable temperature at 78 degrees. The smoke detectors are hardwired and interconnected and observed to be operational. There are carbon monoxide detectors in the facility. Fire extinguishers are located throughout the facility and were last serviced in February of 2021.

The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the showers and toilets. The hot water temperature was measured at 120 degrees F.

Medications-LPA observed medication carts in the nursing station to be locked and inaccessible to residents. There is one ( 01) complete first aid kit.

Exit interview conducted. A copy of this report was issued and signature obtained.
No deficiencies were issued at this time

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022

LIC809 (FAS) - (06/04)

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