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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320032
Report Date: 07/27/2024
Date Signed: 07/27/2024 02:56:06 PM


Document Has Been Signed on 07/27/2024 02:56 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:KENSINGTON REDONDO BEACH, THEFACILITY NUMBER:
198320032
ADMINISTRATOR:MAY, ROBERTFACILITY TYPE:
740
ADDRESS:801 S PACIFICA COAST HIGHWAYTELEPHONE:
(424) 241-2064
CITY:REDONDO BEACHSTATE: CAZIP CODE:
90277
CAPACITY:132CENSUS: 117DATE:
07/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Executive Director Robert MayTIME COMPLETED:
03:10 PM
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On 07/27/24, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Executive Director Robert May.

The facility is licensed to serve 132 non-ambulatory residents, all of which 30 may be bedridden. The facility has a hospice waiver approved 30 residents. The facility currently has 14 residents on hospice. Annual Fees are current.



The facility is a two-story structure located in a residential neighborhood. The facility has three sections within the facility: Assisted Living, Connections, and Haven sections. It consists of 116 bedrooms, 133 bathrooms, shaded courtyard, shaded front yard with water fountain, and trash area in the back of building in the south parking lot.

The first floor includes a kitchen, staff room, laundry room, dining room, library, four restrooms (three inside the building and one outside in the courtyard area), lobby area, reception area, executive office, copy room, hallways, bistro, cinema room (team member desk), electric room, Director of Team Support office, Maintenance closet, French dining room, courtyard with fireplace, dining supplies closet, and activity room.

The second floor includes Connections and Haven sections. The Connections has a closet with medical supplies, spa, linens storage, nursing supply storage, cafe, activity room, family room with fireplace and office, trash closet, electrical closet, toxic supplies closet, and patio. Continue to LIC809-C.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina CloydTELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


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: KENSINGTON REDONDO BEACH, THE
FACILITY NUMBER: 198320032
VISIT DATE: 07/27/2024
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The Haven section has a cafe, activity room with sink, ocean room with balcony and fireplace, laundry room, trash closet, and electrical closet. A medication cart is in all three sections. All walkways, paths and passageways were clean, clear, and free of debris, hazards, and obstructions.

The Executive Director and Associate Executive Director accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards.

Resident (rooms 100, 119, 128, 140, 203, 220, 232A, and 243) bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises.

Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, and hot water temperature properly measured at 116.0°F (room 100) and 116.7°F (room 243). Resident bath towels were adequately stocked.

Common areas were clean and clear of hazards. Doorways were free of obstructions.

LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were kept in locked storage cabinet. First Aid kit was available. Redondo Beach Fire Department completed the facility’s fire and safety inspection on 10/03/2023.

Continue to LIC809-C.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina CloydTELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2024
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: KENSINGTON REDONDO BEACH, THE
FACILITY NUMBER: 198320032
VISIT DATE: 07/27/2024
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Seven (7) staff records were reviewed and 7 out of 7 staff records had the required criminal record clearances or criminal record exemptions.

Nine (9) resident records were reviewed and 9 out of 9 resident records had medical assessments and pre-appraisal or reappraisals. Three residents’ medication was reviewed.

No deficiencies are being cited.

An exit interview was conducted and a copy of this report was discussed and left with the Executive Director Robert May.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina CloydTELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2024
LIC809 (FAS) - (06/04)
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