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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198204079
Report Date: 11/21/2024
Date Signed: 11/21/2024 02:45:12 PM

Document Has Been Signed on 11/21/2024 02:45 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:SPRING SENIOR ASSISTED LIVINGFACILITY NUMBER:
198204079
ADMINISTRATOR/
DIRECTOR:		CRAIG WEECHFACILITY TYPE:
740
ADDRESS:20900 EARL STREETTELEPHONE:
(310) 370-3594
CITY:TORRANCESTATE: CAZIP CODE:
90503
CAPACITY: 51TOTAL ENROLLED CHILDREN: 0CENSUS: 26DATE:
11/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Vice President Special Projects - Stepan SarmazianTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 11/21/2024, the California Department of Social Services (CDSS) – Community Care Licensing Division (CCLD) staff conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Vice President Special Projects - Stepan Sarmazian. CCLD staff explained the purpose of the visit and was accompanied by a staff member inside and outside the facility during this inspection.

The facility is licensed to serve 51 adults ages 60 and above. The facility may retain 12 residents on hospice.

The facility currently has 26 residents.

The facility has Annual Licensing Fees due on 1/9/2025 of $1,448.
Ulysses CoronelTELEPHONE: (323) 981-1755
Socorro LeandroTELEPHONE: 323-981-1755
DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
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: SPRING SENIOR ASSISTED LIVING
FACILITY NUMBER: 198204079
VISIT DATE: 11/21/2024
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The facility is a two-story building located on a main street.
The outside of the facility consists of a Parking Lot and several Outside Patio Areas with shaded seating.
The facility has an Elevator and 2 Emergency Exit Stair Rooms.
The first floor consists of a Living Room, Front Office / Medication Room, Office, Laundry Room, Sitting Area, Storage Rooms, Dinning Room, Industrial Kitchen, Activity Area, Lounge Room, 2 Public Restroom, and 15 Residential Bedrooms.
The second floor consists of a Beauty Shop, Maintenance Room, Storage Rooms, 2 Sitting Areas, 1 Public Restroom, and 22 Residential Bedrooms.

The kitchen area has supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Knives and toxins were kept in locked storage cabinet.

Medications were safe, locked, and inaccessible. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. Documents are posted as mandated. There are fire extinguishers around the premises, and they were last serviced on 11/19/2024. There are landline telephones in the offices and a videoconferencing in the living room area.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro LeandroTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
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: SPRING SENIOR ASSISTED LIVING
FACILITY NUMBER: 198204079
VISIT DATE: 11/21/2024
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Around 5 random residents' bedrooms were checked. Adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Bathroom toilets and water faucets worked properly, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries accessible to residents.

Due to insufficient time this Annual Inspection was unable to be completed.

No deficiencies were cited.

An exit interview was conducted, and a copy of this report was left with the Vice President Special Projects.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro LeandroTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC809 (FAS) - (06/04)
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