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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198204387
Report Date: 11/08/2024
Date Signed: 11/08/2024 12:15:06 PM

Document Has Been Signed on 11/08/2024 12:15 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:AMERICARE ASSISTED LIVINGFACILITY NUMBER:
198204387
ADMINISTRATOR/
DIRECTOR:		RAQUEL R MONZONESFACILITY TYPE:
740
ADDRESS:15422 ROSELLE AVENUETELEPHONE:
(424) 206-4460
CITY:LAWNDALESTATE: CAZIP CODE:
90260
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
11/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:20 AM
MET WITH:Leia Joaquin - Administrator/LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
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On 11/8/2024, the Department of Social Services (DSS) – Community Care Licensing Division (CCLD) staff conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Leia Joaquin Licensee/Administrator. The purpose of the visit was explained to the Licensee/Administrator.

This facility is licensed to serve 6 adults ages 60 and above, of which 1 maybe bedridden, 2 maybe non-ambulatory, and 2 maybe on hospice.

A total of 6 residents are currently residing in this facility.

The Annual Licensing Fees are current.

The facility is a one-story house located in a residential street. The home consists of 6 resident bedrooms, 1 staff bedroom, 2 full bathrooms, 1 kitchen, 1 living room area, 1 dining room area with an office area, 1 attached garage with a laundry area, and 1 backyard patio area with shaded seating.
Ulysses CoronelTELEPHONE: (323) 981-1755
Socorro LeandroTELEPHONE: 323-981-1755
DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024
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: AMERICARE ASSISTED LIVING
FACILITY NUMBER: 198204387
VISIT DATE: 11/08/2024
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Outside grounds were toured and no bodies of water were observed. The patio furniture is under a shaded area and accessible to residents. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises.

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. Last fire drill was conducted on 11/02/2024. Smoke and carbon monoxide detectors were in compliance and operational. There is a fire extinguisher in the kitchen area, and it was last serviced on 3/26/2024. There is a landline telephone and a video-conferencing device in the office area.

6 out of 6 resident’s bedrooms were checked. Mattresses were in good condition, 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
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro LeandroTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024
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: AMERICARE ASSISTED LIVING
FACILITY NUMBER: 198204387
VISIT DATE: 11/08/2024
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Hot water temperature was adjusted to meet temperature requirements. This facility provides residents with hygiene products such as feminine napkins, nonmedicated soap, toilet paper, toothbrush, toothpaste, and comb.

5 staff records were reviewed, 5 out of 5 staff records had required documentation.

5 resident records were reviewed and, 5 out of 5 resident records had required documentation.

A technical violation is being recorded under CCR 87303(a) for not being able to walk through the garage due to too many things on the floor. The Licensee has agreed to organize their garage by 11/26/2024. Residents do not go inside the garage.

No deficiencies are being cited based on LPA observation and record review in accordance with the California Code of Regulations, Title 22.

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

DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024
LIC809 (FAS) - (06/04)
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