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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198204855
Report Date: 04/21/2022
Date Signed: 04/22/2022 04:48:25 PM


Document Has Been Signed on 04/22/2022 04:48 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:AMERICARE ASSISTED LIVINGFACILITY NUMBER:
198204855
ADMINISTRATOR:LEIA D. DIMALANTAFACILITY TYPE:
740
ADDRESS:2420 ROCKEFELLER LANETELEPHONE:
(310) 422-5364
CITY:REDONDO BEACHSTATE: CAZIP CODE:
90278
CAPACITY:6CENSUS: 6DATE:
04/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:08 PM
MET WITH:Leia Dimalanta, LicenseeTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual required visit and an infection control inspection to the above facility. LPA met with Kathleen Santos, Supervisor and later met with Leia Dimalanta, licensee and the purpose of today’s visit was explained.

There are currently (6) residents in the facility. (1) residents are ambulatory and (5) are non-ambulatory. The facility is a single-story structure located in a residential neighborhood. It has a ramp that in front of the facility. It consists (6) bedrooms, (2) full bathrooms, shaded back yard, front yard, laundry room and a detached garage.

LPA and Kathleen toured the entire facility inside and out. Documents are posted as mandated. All bedrooms are occupied by residents and contain the mandated furniture. The (2) bathrooms are clean and operational. First aid kit completes with manual; smoke detectors and carbon monoxide detector were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. 1 staff is complete and 1 resident file with medications are current and complete. Ample supply of perishable and nonperishable food, hot water temperature is 120 degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, 2 fire extinguishers are fully charged. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2022
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: AMERICARE ASSISTED LIVING
FACILITY NUMBER: 198204855
VISIT DATE: 04/21/2022
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During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry, visitors are logged, and temperature checked, sanitizer/soap in both bathrooms and additional sanitation supplies are locked in a storage house. LPA observed staff wearing masks, residents’ private rooms will be converted to isolation rooms (if needed) and required postings throughout the facility. The facility has an approved Mitigation plan. The resident’s temperatures are checked and logged twice a day. PPE's are enough for 30 days.

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 Dimalanta, Licensee and a hard copy of report provided.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana SotoTELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022
LIC809 (FAS) - (06/04)
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