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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198204079
Report Date: 12/10/2024
Date Signed: 12/10/2024 05:26:57 PM

Document Has Been Signed on 12/10/2024 05:26 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:
12/10/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:20 PM
MET WITH:Vice President Special Projects - Stepan SarmazianTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
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On 12/10/2024, the California Department of Social Services (CDSS) – Community Care Licensing Division (CCLD) staff conducted an unannounced continuation Required – 1 Year Inspection to the above-named facility and met with Vice President of Special Projects - Stepan Sarmazian. CCLD staff explained the purpose of the visit.

4 out of 5 resident records had required documentation.
1 resident record did not have their annual Medical Assessment and Appraisal & Needs Service Plan (aka Reappraisal).

5 out 5 staff records had required documentation.

A technical assistance is being provided for CCR87705 Care of Persons with Dementia. The department had a conversation with the Vice President of Special Projects regarding this regulation.
Ulysses CoronelTELEPHONE: (323) 981-1755
Socorro LeandroTELEPHONE: 323-981-1755
DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
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: 12/10/2024
NARRATIVE
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Deficiencies are being cited based on record review in accordance with the California Code of Regulations, Title 22, see LIC809D. A violation regarding resident records.

An exit interview was conducted, Plans of Corrections were reviewed and developed. A copy of this report and appeal rights were discussed and left with the Vice President of Special Projects.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro LeandroTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/31/2024 01:38 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 12/31/2024 12:47 PM

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/10/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 out of 5 resident records did not have an annual Medical Assessment & Reappraisal which poses a potential health and safety risk to persons in care.
POC Due Date: 01/31/2025
Plan of Correction
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The Vice President of Special Projects has agreed to email Socorro.Leandro@dss.ca.gov an updated Medical Assessment & Reappraisal for Resident 1.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ulysses CoronelTELEPHONE: (323) 981-1755
Socorro LeandroTELEPHONE: 323-981-1755

DATE: 12/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/31/2024

LIC809 (FAS) - (06/04)
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