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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198202967
Report Date: 12/20/2024
Date Signed: 12/20/2024 05:44:06 PM

Document Has Been Signed on 12/20/2024 05:44 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 ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:ANAND CARE CENTER IIIFACILITY NUMBER:
198202967
ADMINISTRATOR/
DIRECTOR:		MEHUL PATELFACILITY TYPE:
735
ADDRESS:11143 SOUTH PRARIE AVETELEPHONE:
(310) 419-1225
CITY:INGLEWOODSTATE: CAZIP CODE:
90303
CAPACITY: 20CENSUS: 12DATE:
12/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:49 AM
MET WITH:Mehul PatelTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced required 1- year visit with the primary focus on Infection Control measures and using the new CARE Inspection Tool. Upon arrival at the facility, LPA Bunker conducted a risk assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA Bunker met Administrator Mehul Patel and explained the purpose of today's Annual Inspection. LPA verified that the facility has an approved Mitigation Plan and Infection Control Reports on file. There are currently 12 residents in placement. The facility's annual fees are current.

The following Domains will be observed and reviewed: Infection Control, Physical Plant and Environmental Safety, Operational Requirements, Staffing, Personnel Records-Training, Clients Rights-Information, Clients Records-Incident Reports, Food Service, Health-Related Services, Incidental Medical Services, Disaster Preparedness, and Emergency Intervention, "LPA Bunker will be using this tool and methods that have been developed to improve the efficiency and accuracy of the Department of Social Services facility inspections.

Administrator Mehul Patel and LPA Bunker toured the above facility which is a two-story converted hotel building located in a business area that consists of: 18 bedrooms, 18 bathrooms, a kitchen, a dining room, a laundry room, a storage room, 7 detached carport, shaded area, indoor/outdoor activity areas. During the visit, Mr. Patel and LPA Bunker observed residents' bedrooms and bathrooms.

See continued LIC9099-C page 2
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: ANAND CARE CENTER III
FACILITY NUMBER: 198202967
VISIT DATE: 12/20/2024
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LPA Bunker observed the facility’s infection control practices, screening protocols for residents and visitors, sanitizer, visitor log, and thermometer at the facility entrance. Logs of daily COVID-19 screening and temperature checks of clients and staff were available and updated. PPE supplies are readily available to staff, and an additional supply of Personal Protective Equipment (PPE) was observed. Sufficient liquid soap, paper goods, cleaning, and disinfecting supplies were observed.

Documents were posted as mandated on the wall in the office and a bulletin board in the dining area. The following Title 22 regulated areas were audited and found to be in compliance: Bedrooms contain the required furniture. The client’s bedrooms were inspected for safety, privacy, and comfort. The living areas are clean, and the bathrooms are clean and operational. The first aid kit is fully stocked with a manual, the hot water temperature was measured at 117.2 degrees Fahrenheit, the telephones are working, smoke and carbon monoxide detectors were in compliance, the fire extinguishers are fully charged, medications were centrally stored and properly locked in the laundry room cabinet and records are current, ample supply of perishable and nonperishable food, adequate linen supply, fire/emergency drill conducted on December 02, 2024. There were no firearms on the premises, the client's bedroom windows had no sliding window lock with thumbscrew, all exit doors were in compliance, covered trash cans, and no bodies of water were present. Hazardous items are inaccessible to clients, the yard is free of debris and hazards. Administrator Mehul Patel states staff was given training on dependent adult and elder abuse reporting.

LPA advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing (www.cdss.ca.gov) Provider Informational Notices (PIN) for any updates relating to COVID-19 and other required guidance.

No deficiencies were cited. LPA Bunker provided Administrator Mehul Patel with copies of the LIC809, LIC809-C, LIC858, and LIC859 documents.

An exit interview was conducted.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2024
LIC809 (FAS) - (06/04)
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