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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197802543
Report Date: 02/02/2022
Date Signed: 02/02/2022 04:49:22 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ATHERTON BAPTIST HOMESFACILITY NUMBER:
197802543
ADMINISTRATOR:ANGELA LEEFACILITY TYPE:
741
ADDRESS:214 SOUTH ATLANTIC BLVD.TELEPHONE:
(626) 289-4178
CITY:ALHAMBRASTATE: CAZIP CODE:
91801
CAPACITY:518CENSUS: 29DATE:
02/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Angela Lee, AdministratorTIME COMPLETED:
05:00 PM
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censing Program Analyst (LPA) Cynthia Chan conducted an unannounced required annual inspection with the focus of the Infection Control domain. LPA met with Administrator Angela Lee, and explained the purpose of the visit. The facility is licensed as a Continuing Care Residential Community (RCFE-CCRC) to serve 518 residents, 60 years and above, of which 259 may be non-ambulatory. The hospice waiver is approved for 10 residents. There are currently 26 Assisted Living residents, 3 residents in the Memory Care unit, 88 residents in Skilled Nursing, and 274 residents in Independent Living.

LPA Chan toured the community with the Administrator for the Assisted Living and Memory Care units, in addition to the common areas of the facility. The facility has a universal screening at the front lobby for staff and visitors. Temperature are taken and documented on the sign in log. LPA observed Coronavirus (COVID-19) signage posted throughout the facility. The Assisted Living unit and Memory Care unit are detached from the main building. The Assisted Living unit consists of 32 individual apartments with their own bathrooms and a shared dining area. The dining room tables are socially distanced. The Memory Care unit consists of 4 bedrooms, one t.v room, 1.5 bathroom, living room, dining room, and kitchen. There is an alert system installed at all the doors. The cleaning solutions are stored and locked in the cabinet besides the laundry machine. There are sufficient supplies of 2 day perishable and a week of nonperishable items observed. The smoke detectors are hard wired and operable. The fire extinguishers were last inspected on 7/8/21. The hot water temperature was measured between the required range of 105-120 degrees Fahrenheit. Medications are centrally stored and locked in the nursing station. LPA randomly selected 6 residents medications for review and did not observe any deficiencies in this area. Per Administrator, they are following guidance set by CCL and updating protocols as needed.

There are no discrepancies observed during the visit today. Exit interview was conducted and a copy of this report along with appeal rights were given to the Administrator.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D ChanTELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022
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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