198204758-8-26-2021-11-AS-PBUR-C69LR8-20210826085842

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198204758
Report Date: 08/25/2021
Date Signed: 08/26/2021 08:59:32 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	BROOKDALE OCEAN HOUSE		FACILITY NUMBER:	198204758
ADMINISTRATOR:	PARK, THOMAS		FACILITY TYPE:	740
ADDRESS:	2107 OCEAN AVE		TELEPHONE:	(310) 399-3227
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90405
CAPACITY:	150	CENSUS: 91	DATE:	08/25/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Tom Rekowski		TIME COMPLETED:	03:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced Required - 1 Year Annual visit. The primary focus is on the Infection Control measures using the new CARE Inspection Tools. Upon arrival at the facility, LPA Bunker called the above facility and spoke to Lead Receptionist Rose Linesch via telephone and conducted a risk assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA verified that the facility has an approved Mitigation Plan Report. LPA was properly screened for COVID-19 symptoms and temperature was checked. LPA observed a sanitizing station at the facility entrance; visitors log with COVID-19 screening and temperature log, and records of daily COVID-19 screening and temperature checks of residents and staff. PPE supplies are readily available to staff, and an additional 30-day supply of PPE is stored in the storage room; sufficient paper, cleaning, and disinfecting supplies were observed. LPA reviewed the facility’s surveillance testing records. Executive Director Tom Rekowski stated that all staff except one is fully vaccinated. The facility residents are also vaccinated. The facility is doing COVID-19 testing weekly. Executive Director Mr. Rekowski and LPA Bunker toured the facility inside and outside grounds. 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 (8) deluxe studio See continued LIC809-C on page #2

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: BROOKDALE OCEAN HOUSE	FACILITY NUMBER: 198204758
	VISIT DATE: 08/25/2021

NARRATIVE

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Continued LIC809-C page #2

Common area includes 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, TV/movie theater room. All areas were observed to be properly furnished, free of hazards, and appropriate for group activities.

The kitchen was inspected and observed to be clean and operational. In addition, appliances and fixtures appeared functional. Daily Activity Schedule and meal menu observed to be posted at the concierge desk, lobby, and inside the elevators. Refrigerated and frozen foods were stored at proper temperatures. Residents do not have access to the kitchen. The facility menu appears to meet the daily dietary needs for the residents. All toxins and knives are locked/secured and inaccessible to residents. There were no pesticides or poisons observed near any food areas.

LPA Bunker inspected ten (10) resident's apartments they were inspected for, safety, privacy, and comfort. The living areas are clean. Resident apartments were found to be clean, well furnished, and in good repair. The resident's apartment’s windows have no sliding window locks with thumbscrews. All resident's rooms have private bathrooms. The living areas are clean. LPA observed the following during inspection of resident’s apartments: mattresses are in good condition, adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. All rooms inspected appeared properly furnished, sanitary and free from hazards. Bathrooms contained the required grab bars, and showers/tubs had non-slip safety bath mats. LPA observed bathrooms clean and operational.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: BROOKDALE OCEAN HOUSE	FACILITY NUMBER: 198204758
	VISIT DATE: 08/25/2021

NARRATIVE

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Continued LIC809-C page #3

The following Title 22 regulated areas were audited and found to be in compliance: Apartments contain the required furniture. First aid kit is fully stocked with manual, hot water temperature in apartments #206; #212; #309; #314; #415; #417; #505; #515; #608; and #615 measured at 112.5 to 113 degrees Fahrenheit. The facility has working telephones. The facility has an installed hardwired smoke alarm system. Apartments smoke and carbon monoxide detectors were in compliance. Each resident apartment has a night light and push bottom alert system, in the bathroom, for emergency assistance, as well, each resident wears a call alert pendent for immediate emergency assistance. The facility has two working elevators. The fire extinguishers are fully charged. Medications were centrally stored and properly locked on the 2nd-floor medication room in the records are current and documented on the Point Click Care Electronic Medical Records system. LPA Bunker observed an ample supply of perishable and nonperishable food, adequate linen supply, and covered shaded patio areas. The fire/emergency drill was conducted on 08/16/2021. No firearms on the premises, all exit doors were in compliance, covered trash cans, and no bodies of water present. Hazardous items are inaccessible to clients, the yard is free of debris and hazards.

Mr. Rekowski states staff was given training on dependent adult and elder abuse reporting.

There were no deficiencies cited.

LPA Bunker provided Mr. Rekowski with copies of the Facility Evaluation Reports.

Exit interview conducted

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

LIC809 (FAS) - (06/04)

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