198205318-3-22-2024-11-AS-WGIS-D3LV3Q-20240322160507

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198205318
Report Date: 03/22/2024
Date Signed: 03/22/2024 04:05:53 PM

Document Has Been Signed on 03/22/2024 04:05 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	AMERICARE ASSISTED LIVING OF WALTERIA		FACILITY NUMBER:	198205318
ADMINISTRATOR:	MARLOWE ANTHONY JOAQUIN		FACILITY TYPE:	740
ADDRESS:	2638 PACIFIC COAST HIGHWAY		TELEPHONE:	(310) 326-1838
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90505
CAPACITY:	6	CENSUS: 5	DATE:	03/22/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:34 PM
MET WITH:			TIME COMPLETED:	04:00 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 03/22/24, Licensing Program Analyst (LPA), Wendy Gibbs and Darneshia Cross, conducted and unannounced annual visit at the facility listed above. LPAs met with Caregiver, Whilma Torres and was later joined by Administrator, Anthony Joaquin, and the purpose of today’s visit was explained. During today’s visit there were five (5) residents present. Physical Plant/Structure The facility is a single-story home in a residential neighborhood. The facility consists of six (6) bedrooms, 3 and ½ bathrooms, 2 living room, dining room, kitchen, laundry room, and detached two (2) car garage. Outside LPA’s observed a shaded area with table and chairs for residents. LPAs observed all walkways to be clean, clear, and free of debris, hazards, and obstructions. Bedrooms LPAs inspected all bedrooms and observed rooms to be clean and in good repair. All rooms had the required furniture including a bed, dresser, chair, and ample storage space for resident’s personal belongings. LPAs observed the beds had the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillows. LPA observed an ample supply of linens in the closet in the hallway.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024

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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: AMERICARE ASSISTED LIVING OF WALTERIA	FACILITY NUMBER: 198205318
	VISIT DATE: 03/22/2024

NARRATIVE

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Bathroom LPAs observed the bathrooms to be clean and operational. LPA’s observed secured safety handrails, a shower chair, and non-skid mat. LPA observed an ample supply of towels in the hall closet. LPAs observed an ample supply of hygiene products in the hall closet. The water temperature in the bathrooms measured 118.9-degrees, 117.7-degrees, and 119.9-degrees Fahrenheit
Common Rooms LPA’s observed couches and recliners in the living areas to accommodate all residents. LPAs observed a large dining table and enough chairs to accommodate all residents. LPAs observed all walkway and hallways in the facility to be clean, clear, and free of obstructions and debris. All rooms and hallways were observed to have ample lighting.
Kitchen LPAs observed all appliances to be operational and in good repair. LPAs observed an ample supply of cookware, dishware, and cutleries. LPAs observed a 3-day supply of perishable foods and a 7-day supply of non-perishable foods properly stored, labeled, and dated. The water temperature measured 120-degrees Fahrenheit. All cleaning supplies are secured in a locked cabinet under the kitchen sink and are inaccessible to residents. All knives and sharps are secured in a locked drawer in the kitchen and are inaccessible to residents.
Files/Interviews LPA reviewed the files for five residents and found they contained the required documents. LPA reviewed the files for four staff and found they contained the required documents, training, and certification. LPA reviewed the Liability insurance. LPAs interviewed four residents and they are happy with the care, assistance, and service they receive at the facility. LPAs interviewed two staff who were able to answer questions regarding resident care, personal rights, and policy. LPAs did inform the Administrator that their Licensing fees are due on 03/31/24 and provided them with the PIN.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024

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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: AMERICARE ASSISTED LIVING OF WALTERIA	FACILITY NUMBER: 198205318
	VISIT DATE: 03/22/2024

NARRATIVE

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Medications LPAs observed centrally stored medication secured in a locked cabinet in the kitchen and are inaccessible to residents. LPA’s observed medications in their original containers. LPAs reviewed residents Medication Administration Records (MARs) and medications for five residents. Five out of five resident’s MARs and medications are consistent with properly documented records.
Safety LPAs observed a fully charged fire extinguisher, mounted in the living room, last serviced on 03/22/23. LPAs observed all smoke detectors and carbon monoxide detectors to be operable. The last fire inspection was conducted on 02/07/24 by the Torrance Fire Department. LPAs observed all required documents posted throughout the facility. LPAs inspected the First Aid kit and found it contained the required item and an updated manual. No firearms or ammunition are stored at the facility.
Infection Control LPAs observed a sanitizing station at the facility entry. Visitors are screened before enter and sign-in on the visitor log. LPAs observed PPE’s, hand sanitizer, and thermometer on the sanitizing station. LPAs observed a 30-day supply of PPEs at the facility. LPAs observed all required Infection Control Signs posted throughout the facility.

LPAs did not observe or cite any deficiencies.

An exit interview was conducted with Administrator, Anthony Joaquin, and a copy of this report was provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024

LIC809 (FAS) - (06/04)

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