198204999-6-26-2023-11-AS-WGIS-CT6T45-20230626142323

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198204999
Report Date: 06/26/2023
Date Signed: 06/26/2023 02:23:32 PM

Document Has Been Signed on 06/26/2023 02:23 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	AMERICARE ASSISTED LIVING OF WESTCHESTER		FACILITY NUMBER:	198204999
ADMINISTRATOR:	PATRICK BAUTISTA		FACILITY TYPE:	740
ADDRESS:	8501 RAMSGATE AVENUE		TELEPHONE:	(310) 641-5808
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90045
CAPACITY:	6	CENSUS: 6	DATE:	06/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:22 AM
MET WITH:	Leia Joaquin		TIME COMPLETED:	02:30 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	On 06/26/23, Licensing Program Analyst (LPA), Wendy Gibbs, conducted a required unannounced annual visit at the facility listed above. LPA Gibbs met with Licensee, Leia Joaquin, and explained the purpose of today’s visit. During today’s visit, 6 Residents were present. Two (2) of the Residents are on Hospice Care. Structure The facility is a two-story home in a residential neighborhood. The facility has six (6) Resident rooms, two (2) Resident bathrooms, one (1) Staff bedroom, one (1) Staff bathroom, living room, dining room, kitchen and attached garage. Physical Plant LPA Gibbs and Staff Marlowe (Anthony) Joaquin toured the physical plant. The front and back yard are well maintained. LPA Gibbs observed a table with umbrella, and chairs available for Resident use. All entrances in and out of the home are clear. LPA observed the walkways along the side of the house to be clean, clear, and free of obstructions, hazards, and debris. Both gates on the side of the house open easily to exit. Bedrooms LPA Gibbs toured all rooms in the home. All rooms were observed to have the required furniture including bed, chair, dressers, nightstand, and storage space for Resident’s belongings. All Resident rooms were observed to have ample lighting. Walls and floors in the bedrooms were observed to be clean and in good repair. Bathrooms LPA observed the resident bathrooms to be within Title 22 Regulations. They were observed to be clean and operational. The toilets, wash bins, and showers were in good working repair. The security handrails were securely fastened to the wall, the showers had shower chairs and nonskid mats. LPA observed an ample supply of stored toiletries available for Residents. The water temperature in the bathrooms measured 107.9-degrees and 106.3-degree Fahrenheit. Linens & Hygiene LPA observed all beds have the required linens including mattress cover, fitted sheets, blanket, comforter, and pillow. LPA observed an ample supply of bed linens and blankets in resident’s rooms. LPA observed an ample supply of incontinent care items stored in resident rooms and additional supply in the attached garage.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: AMERICARE ASSISTED LIVING OF WESTCHESTER	FACILITY NUMBER: 198204999
	VISIT DATE: 06/26/2023

NARRATIVE

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Kitchen LPA inspected the kitchen and observed it to be clean and sanitary. LPA observed an ample supply of cutleries, pots, and pans to be in good repair. All appliances were tested and are in good working repair. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods. All food was stored and labeled properly. LPA observed cleaning supplies and detergent to be secured in a locked cabinet under the kitchen sink. All knives and sharps were observed to be secured in a locked cabinet above the sink. The water temperature measured 106.3-degrees Fahrenheit.
Common Rooms LPA toured all rooms at the facility. In the dining room, LPA observed a long rectangle dining table and chairs to accommodate all Residents. The living room has recliners for all Residents. LPA observed games and activities stored on a shelf in the living room. All walkways and hallways were clean, clear, and free of hazards and obstructions. The facility was maintained at a comfortable temperature.
Safety During the tour, LPA observed smoke/carbon monoxide detectors in all bedrooms, hallways, and living room. An additional Carbon Monoxide Detector was observed in the dining room. LPA observed two (2) fully charged fire extinguishers, last serviced on 03/27/2023. One was mounted on the wall near the entrance of the facility and the second was mounted on the wall in the kitchen. The fire alarms and sprinkler system were last serviced and inspected on 03/27/2023. Emergency drills are conducted monthly and the last one was on 06/12/23. LPA inspected the First Aid Kit and observed it had the required items and a manual. All doors that exit the facility are equipped with a delayed egress system. The facilities landline telephone was tested and is operable. LPA observed all required CCL signs posted at the entrance and office space cork board. There are no firearms or ammunition stored at the facility.
Infection Control Upon arrival to the facility the door had signs posted, informing visitors they will not enter without a mask and if you have any symptoms of a sickness to not enter. Upon entry a visitors temperature is taken and logged on the sign in sheet. At the entrance is a sanitizing station with Personal Protective Equipment (PPEs) available. LPA observed an additional 60-day supply of PPEs stored in the attached garage. LPA observed infection control signs posted throughout the facility. LPA observed all staff to have a face mask on.
Medications LPA observed Centrally Stored Medications to be secured in a locked cabinet in the kitchen and are inaccessible to Resident’s. LPA reviewed all Resident’s Centrally Stored Medications and matched them to the Medication Administration Record (MAR) form. Medications that were reviewed matched the MARs.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: AMERICARE ASSISTED LIVING OF WESTCHESTER	FACILITY NUMBER: 198204999
	VISIT DATE: 06/26/2023

NARRATIVE

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File Review & Interviews LPA reviewed all six (6) Resident files and found they contained the required documents. LPA reviewed two (2) Staff and Administrator files. All files reviewed had the required documents, training, and certification. LPA received a copy of the facilities Liability Insurance Policy. LPA conducted two (2) staff interviews, both staff were able to answer questions regarding resident care and personal rights. At time of visit all Residents were sleeping or did are on hospice care and were not available for interviews.

No deficiencies were cited during today’s visit.

LPA conducted an exit interview with Staff, Cherry Valencia, due to Licensee having to leave. A copy of this report was provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023

LIC809 (FAS) - (06/04)

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