198204079-4-13-2022-11-AS-LMOA-CDFMDU-20220413093144

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198204079
Report Date: 03/22/2022
Date Signed: 04/13/2022 09:31:52 AM

Document Has Been Signed on 04/13/2022 09:31 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

FACILITY NAME:	SPRING SENIOR ASSISTED LIVING		FACILITY NUMBER:	198204079
ADMINISTRATOR:	CRAIG WEECH		FACILITY TYPE:	740
ADDRESS:	20900 EARL STREET		TELEPHONE:	(310) 370-3594
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90503
CAPACITY:	51	CENSUS: 33	DATE:	03/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Craig Weech		TIME COMPLETED:	12:05 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 3/22/2022, Licensing Program Analysts (LPA) Lourdes Montoya conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. Upon arriving at the facility, LPA met with Administrator Craig Weech who granted access and allowed LPA to enter the facility to conduct an annual inspection. The facility is licensed to serve 51 non-ambulatory residents age 60 and over. The facility may retain twelve (12) residents on hospice. Currently, there are six (6) Hospice residents present during today’s visit. Thirty-three (33) residents and eleven (11) staff were present in the facility during this inspection. The facility does not handle residents’ cash resources. Facility Annual Fees are current during today’s visit. Administrator's certificate expires 4/28/2023. During the visit, LPA toured the inside and outside grounds of the facility with Administrator Weech. This facility consists of fifteen (15) private resident bedrooms, kitchen, living room, activity/entertainment room, dining room, two common bathroom, a laundry room and a patio on the first floor. There are twenty-two resident bedrooms and one common bathroom on the second floor. Four operable carbon monoxide in common areas and smoke detectors in resident bedrooms and hallways were observed. Fire extinguishers were last serviced on 2/7/2022. The facility has interconnected fire sprinklers. The last facility fire drill was on 2/15/2022. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, and toxins were stored and not accessible to clients. The kitchen was inspected and there is sufficient 2-day perishable and 7-day non-perishable food available. Report Continued in LIC 809-C

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (323) 981-4934
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

FACILITY NAME: SPRING SENIOR ASSISTED LIVING	FACILITY NUMBER: 198204079
	VISIT DATE: 03/22/2022

NARRATIVE

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There are no pools or bodies of water on the premises. There are no firearms on the premises or other dangerous weapons. Centrally stored medications are locked in a cabinet located in the medication room. The first aid kit has all required supplies. Toxic chemicals are locked and inaccessible to residents. The facility has a written emergency disaster plan posted in the living room. The facility is maintained at a comfortable temperature of 74 degrees F. LPA observed hot water temperature in the following resident bedrooms: #204 at 109.5 degrees F, #200 at 106.7 degrees F, #103 at 107.6, and #116 at 118.6 degrees F. There are working lights or lamps in each room at the time of visit. There are grab bars for each toilet and shower used by residents. Showers have non-skid floors.

During the visit, LPA observed the following to be in compliance: facility's infection control practices; screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms; every staff was wearing a face covering; the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has a Mitigation Plan Report approved by CCLD.

No deficiencies cited during this visit.

Exit interview conducted. A copy of this report was provided to the Administrator Craig Weech.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (323) 981-4934
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

LIC809 (FAS) - (06/04)

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