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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198204758
Report Date: 08/28/2024
Date Signed: 08/28/2024 03:04:11 PM


Document Has Been Signed on 08/28/2024 03:04 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245



FACILITY NAME:BROOKDALE OCEAN HOUSEFACILITY NUMBER:
198204758
ADMINISTRATOR:HELEN LEEFACILITY TYPE:
740
ADDRESS:2107 OCEAN AVETELEPHONE:
(310) 399-3227
CITY:SANTA MONICASTATE: CAZIP CODE:
90405
CAPACITY:150CENSUS: 85DATE:
08/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:14 AM
MET WITH:Helen LeeTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one-year inspection. LPA met with Helen Lee, Executive Director and the purpose of the visit was discussed. Facility is licensed to serve 150 non- ambulatory elderly residents and an approved hospice waiver for 5 resident. None of the residents are diagnosed with dementia or receiving home health or hospice care services. The facility does not handle any of the residents’ money. LPA reviewed 8 resident and 8 staff records along with medication records during this visit.

The facility is a 10-story high-rise apartment building located in a residential beach neighborhood. The facility consisted of the following: 116 apartment units/with bathrooms, (16) 1- bedroom, (92) studio, and (7) deluxe studio. The facility also includes the following:1st-floor concierge desk, open patio area, in front of the facility, with patio chairs, (2) living rooms with piano and audio speaker sound system, restaurant style dining room, private dining room for special occasions, and a kitchen. The 2nd-floor includes an exercise/game room and wellness/medication room. The 3rd-floor includes a beauty salon including a manicure/pedicure station. The 10th-floor includes a library/computer/lounge room, activity/ exercise room, outside patio/ garden area and TV/movie theater room. All areas were observed to be properly furnished, free of hazards, and appropriate for group activities.

LPA and Executve Directorr toured the Resident bedrooms on the 10th floor, room 1003, the 8th floor room 815, the 7th floor room 710, the 6th floor rooms 607 and 611, the 5th floor rooms 506 and 516, 2nd floor room 204. All had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured between 120 F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Sparkle DayTELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2024
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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: BROOKDALE OCEAN HOUSE
FACILITY NUMBER: 198204758
VISIT DATE: 08/28/2024
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Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents on the 2nd floor Medication room. Smoke detectors were working properly and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the facility were clear of hazards. There are no security bars or weapons on the premises.

During todays visit LPA did not observe any deficiencies.

Exit interview conducted with Helen Lee, Executive Director and a copy of the report was provided.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Sparkle DayTELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC809 (FAS) - (06/04)
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