198204855-2-29-2024-11-AS-AINZ-D2WTE5-20240229133921

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198204855
Report Date: 02/29/2024
Date Signed: 02/29/2024 01:39:26 PM

Document Has Been Signed on 02/29/2024 01:39 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:	AMERICARE ASSISTED LIVING		FACILITY NUMBER:	198204855
ADMINISTRATOR:	LEIA D. DIMALANTA		FACILITY TYPE:	740
ADDRESS:	2420 ROCKEFELLER LANE		TELEPHONE:	(310) 422-5364
CITY:	REDONDO BEACH	STATE: CA	ZIP CODE:	90278
CAPACITY:	6	CENSUS: 6	DATE:	02/29/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:14 AM
MET WITH:	Marjanna Abraham-Caregiver		TIME COMPLETED:	01:38 PM

NARRATIVE

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On 2/29/2024, Licensing Program Analysts (LPA) Darneisha Cross and Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Leia Dimalanta / Licensee. LPA explained the purpose of today’s visit. The facility is licensed to serve (6) residents ages 60 and above. Of which (6) may be non-ambulatory . Facility has an approved hospice waiver for (1) and Bedridden for (1) but it was placed on the duplicate facility.

The facility is a single-story structure located in a residential neighborhood. It consists of (6) bedrooms, (2) full bathrooms, shaded back yard, front yard, laundry room, and unattached 2 car garage.

LPA toured the physical plant with staff. There were no bodies of water or obstructions on the premises. A total of (5) rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident’s personal belongings was observed. Bathrooms were found to be within Title 22 regulations and were operational. LPA inspected the carbon monoxide detectors combo were in operable conditions. The water temperature measured: Kitchen 126.4°F, Bathroom #1:125.°F.

Evaluation Report Continues LIC 809-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024

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: AMERICARE ASSISTED LIVING	FACILITY NUMBER: 198204855
	VISIT DATE: 02/29/2024

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LPA Iniguez observed the facility to be clean, sanitary, and appropriately furnished at the time of the visit. Storage areas for personal hygiene were observed, cleaning agents found unlocked underneath bathroom sink. Sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. All fire extinguishers were charged and were operable. A review of (3) residents' service files, (3) staff personnel files were checked. (3) Medication Administration Records (MAR) were reviewed no discrepancies were found. First AID kit was checked. Last fire disaster drill was on:2/13/2024.

LPA observed the facility's infection control practices. Liability insurance was provided to LPA during visit. Facility Annual Fees Current. During annual inspection, LPAs discovered that they are two different facility numbers under the name of Americare Assisted Living. LPA advised the licensee to follow up with her LPA caring case about separating both facilities.

Deficiency cited under California Code of Regulations, Title 22, Division 6, Chapter 8. See details below:

-Water temperature over 120F. (126.4F in kitchen and 125.F in bathroom).

-Unlocked cleaning agents found in bathroom. (Picture taken by LPA).

An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Leia Dimalanat /Licensee.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/29/2024 01:39 PM - It Cannot Be Edited

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: AMERICARE ASSISTED LIVING	FACILITY NUMBER: 198204855
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87303(e)(2)

Maintenance and Operation

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) the licensee did not comply with the section cited above in having the tap water temperature over 120F which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/01/2024
	Plan of Correction
1 2 3 4	Licesensee will ensure that the termperaure of the facility will be under 120F. As a POC the licensee will measure the water temperature every hour for 24 hours. Proof of water log will be sent to LPA via email before POC due date.

Type A

Section Cited

CCR

87309(a)

Storage Space

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) the licensee did not comply with the section cited above in having cleaning agents which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/01/2024
	Plan of Correction
1 2 3 4	Licesensee will ensure that cleaning agents are locked at all times. Licensee conducted in service during LPA visit.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 02/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024

LIC809 (FAS) - (06/04)

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