198204387-11-13-2023-11-AS-FSHY-CXJRFJ-20231113115914

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198204387
Report Date: 11/13/2023
Date Signed: 11/13/2023 11:59:18 AM

Document Has Been Signed on 11/13/2023 11:59 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	AMERICARE ASSISTED LIVING		FACILITY NUMBER:	198204387
ADMINISTRATOR:	RAQUEL R MONZONES		FACILITY TYPE:	740
ADDRESS:	15422 ROSELLE AVENUE		TELEPHONE:	(424) 206-4460
CITY:	LAWNDALE	STATE: CA	ZIP CODE:	90260
CAPACITY:	6	CENSUS: 5	DATE:	11/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Leia D. Joaquin, Administrator		TIME COMPLETED:	12:30 PM

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Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced Annual required and infection control visit to the above facility. LPA was met by Leia Joaquin, Administrator and the purpose of today’s visit was explained. There are currently (5) residents in placement.

The facility is a single-story structure located in a residential neighborhood. It consists (7) bedrooms, (2) full bathrooms, ramp along side north side and back of facility, shaded back yard, and a front yard with an attached garage that houses the washer and dryer.

LPA Shirley and Leia walked through the kitchen and all appliances were in good working order. Knives were locked and stored under the sink in the kitchen and inaccessible to residents. LPA observed a 3-day supply of perishable and a 7-day supply of nonperishable foods. The water temperature measured 118.9 degrees Fahrenheit. All bathrooms were checked, sufficient liquid soap and paper towels were observed. Toilets and water faucets worked properly. The walk-in shower was free of mildew and mold.

LPA Shirley and Leia walked through all common areas. In the living room, kitchen, dining room there is ample seating and space for all residents. All rooms and walkways were clean, and clear of obstructions and hazards. All areas have ample lighting. All rooms, hallway, and living room have working smoke detectors. There is a charged fire extinguisher in the kitchen and hallway.

LPA Shirley and Leia toured the entire facility inside and out. Documents are posted as mandated. Bedrooms 1-5 are occupied by residents and contain the mandated furniture. Bedroom 7 is a staff bedroom. The (2) bathrooms have grab bars and are clean and operational. First aid kit is fully stocked with manual. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. (1) Resident file along with medications are current. (1) Staff file is current. The facility is in good repair. PPE's will last for 30 days plus.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time.

An exit interview conducted with Leia Joaquin, Administrator and a hard copy of report provided.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa Shirley	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023

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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