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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197800131
Report Date: 07/25/2024
Date Signed: 08/13/2024 08:06:34 AM


Document Has Been Signed on 08/13/2024 08:06 AM - 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:CHATEAU LONG BEACHFACILITY NUMBER:
197800131
ADMINISTRATOR:KHATERA BAHADORYFACILITY TYPE:
740
ADDRESS:3100 E. ARTESIA BLVD.TELEPHONE:
(562) 428-5371
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:184CENSUS: 79DATE:
07/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Director Khatera BahadoryTIME COMPLETED:
12:45 PM
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On 07/25/24, Licensing Program Analyst (LPA) Lizeth Villegas conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with administrator Khatera Bahadory and explained the purpose of today’s visit. The facility is licensed to serve (184) of which (178) non-ambulatory and (6) bedridden elderly adults ages 60 and above. The facility is approved for (12) hospice residents. Facility fees are current, liability insurance is active with expiration date of 03/01/25.

The facility is a two-story structure located in a commercial neighborhood that consists of the following: reception area, (80) resident bedrooms with a bathroom in each unit, (4) public bathrooms, an activity room, kitchen, a large dining room, laundry room, medication room, a PT room, administrative offices, (3) outside patios, and storage areas for personal hygiene, cleaning supplies, emergency food/water supply were observed. A landline and internet service were observed. LPA checked both downstairs and upstairs bedrooms, beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident’s personal belongings was observed. Call buttons, smoke and carbon monoxide detectors are all operable conditions. Last fire safety check was conducted on 06/07/24. There were no bodies of water, fire arms, nor obstructions on the premises. LPA observed the facility to be clean, sanitary, and appropriately furnished at the time of the visit. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Sharps and toxins were stored and not accessible to residents. All fire extinguishers were charged and were operable. A review of (6) resident files (4) staff personnel files, medication Administration Records (MAR), no discrepancies were observed.

During today’s visit no discrepancies were cited.

Exit interview conducted with Administrator Khatera Bahadory, and a copy of this report was provided.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth VillegasTELEPHONE: (818) 391-9974
LICENSING EVALUATOR SIGNATURE:
DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2024
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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