198320018-5-27-2021-11-AS-TAGD-C3F4FV-20210527190435

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320018
Report Date: 05/27/2021
Date Signed: 05/27/2021 07:05:34 PM

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:	SUNRISE OF BEVERLY HILLS		FACILITY NUMBER:	198320018
ADMINISTRATOR:	MALONE, JASON		FACILITY TYPE:	740
ADDRESS:	201 NORTH CRESCENT DR		TELEPHONE:	(310) 274-4479
CITY:	BEVERLY HILLS	STATE: CA	ZIP CODE:	90210
CAPACITY:	127	CENSUS: 56	DATE:	05/27/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Jason Malone		TIME COMPLETED:	03:10 PM

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On 05/27/2021, Licensing Program Analyst (LPA) Troy Agard conducted an unannounced required annual visit with a primary focus on Infection Control measures using the new CARE Inspection Tools. Upon arrival at the facility, LPA Agard called the front desk staff and conducted a risk assessment over the telephone. Based on the assessment, the facility is clear of Covid-19 infection. LPA verified that the facility has an approved mitigation plan report.

The facility is licensed for 127 non-ambulatory residents, of which (9) may be bedridden and an approved hospice waiver for (20) residents.

LPA met with the Administrator and both toured the inside and outside grounds of the facility. LPA was properly screened for Covid-19 symptoms and temperature was checked. LPA was properly equipped with Fit tested N-95.

During the tour, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance and throughout; visitors log with Covid-19 screening, and temperature log. PPE supplies are readily available to staff, residents and visitors. Sufficient food supplies were observed. The facility’s designated visitation areas are in residents’ room, outdoors and in a private communal area. LPA observed all staff, some residents, and visitors maintain 6 feet physical distancing, and wearing a face covering. LPA observed required postings throughout the facility.

LPA reviewed the facility’s surveillance testing records. A review of N-95 Fit Testing records was conducted. Staff have completed the N-95 fit testing.

The facility consists of assisted living and has a memory care unit. Potentially dangerous items, including sanitizers, are kept inaccessible to residents with dementia.

Bathroom in common area was checked, sufficient liquid soap and paper towels were observed. A vacant staged room was inspected. Toilets and water faucets worked properly; grab bars were secure in restroom.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021

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: SUNRISE OF BEVERLY HILLS	FACILITY NUMBER: 198320018
	VISIT DATE: 05/27/2021

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The water temperature measured at 113 F. A comfortable temperature was maintained throughout the facility.

LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food dated. Knives and toxins were not observed accessible to residents in care. First Aid kit was observed in the facility. Fire extinguishers were observed throughout the facility.

Outside grounds were toured, and no bodies of water were observed. Walkways around the facility were clear of hazards. Common areas were clean and clear of hazards; doorways were free of obstructions.

No deficiencies were cited during this visit.

An exit interview was conducted, and a copy of this report was provided to Administrator.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021

LIC809 (FAS) - (06/04)

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