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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197802543
Report Date: 02/14/2023
Date Signed: 02/14/2023 03:16:37 PM


Document Has Been Signed on 02/14/2023 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
GREATER LA AC/SC, 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: 30DATE:
02/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Angela Lee, AdministratorTIME COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the 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 28 Assisted Living residents and 2 residents in the Memory Care unit.

LPA toured the Assisted Living community and the Memory Care unit with the Administrator. All visitors check in at the front lobby for temperature and routine symptom screening for COVID-19. The COVID-19 signage are posted at the main entrance and has a voluntary rapid testing station. The memory care unit is located across from the main building which consists of 4 bedrooms, one t.v room, 1.5 bathroom, living room, dining room, and kitchen. Proper COVID-19 signage are posted at the home. The assisted living building is located behind skilled nursing. The Assisted Living unit consists of 32 individual apartments with their own bathrooms, a communal activity area, and the medication room. There are hand sanitizer stations throughout the facility. Extra soap and paper towels are available. The facility has sufficient PPE supplies for at least 30 days. Tables and chairs in the communal areas and dining area are set up with social distancing. The facility has isolation carts with PPE supplies for use during any positive COVID-19 cases. The housekeepers are employed daily to ensure proper cleaning and disinfecting. LPA checked the medications for 5 residents and they are being administered as prescribed. The emergency contact information for residents are up-to-date. Per Administrator, they are still following the strictest COVID-19 guidance and have backup staffing if needed to assist residents.

No deficiencies observed today. An exit interview was held and a copy of this report was given to the Administrator.
SUPERVISOR'S NAME: Tony VasalloTELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D ChanTELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2023
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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