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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197800131
Report Date: 08/11/2023
Date Signed: 08/11/2023 03:16:33 PM


Document Has Been Signed on 08/11/2023 03:16 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: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: 102DATE:
08/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Khatera BahadoryTIME COMPLETED:
03:00 PM
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On 8/11/23, 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 (6) hospice residents.

The facility is a two-story structure located in a commercial neighborhood. It consists of the following: Eighty (80) resident bedrooms with a bathroom in each unit, four (4) public bathrooms, a reception area, beauty shop, an activity room, a kitchen, a dining, a laundry room, a medication room, three (3) outside patios, and offices. Facility is currently having construction done on the 1st floor, CCL was informed of construction dates.

LPA toured the physical plant with Bahadory. There were no bodies of water or obstructions on the premises. All rooms were inspected. 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 drill conducted on 8/4/23.

LPA observed the facility to be sanitary and appropriately furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. All fire extinguishers were charged and were operable. Several working landline phones are available on-site. A review of ten (10) resident files (4) staff personnel files, Medication Administration Records (MAR) and P&I Ledgers were all maintained in order. A current liability insurance effective 03/01/23 - 03/01/24 was on file.
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: (323) 981-3328
LICENSING EVALUATOR NAME: Lizeth VillegasTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2023
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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