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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320114
Report Date: 08/31/2023
Date Signed: 08/31/2023 04:59:38 PM


Document Has Been Signed on 08/31/2023 04:59 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:SUNCOAST SENIOR LIVING AT LONG BEACHFACILITY NUMBER:
198320114
ADMINISTRATOR:KIM, KI HWANFACILITY TYPE:
740
ADDRESS:2520 GONDAR AVETELEPHONE:
(718) 683-1000
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY:6CENSUS: 5DATE:
08/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Ki H. KimTIME COMPLETED:
05:15 PM
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On 8/31/2023, Licensing Program Manager (LPM) Ulysses Coronel & Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced annual required visit. LPM & LPA met with administrator Ki Hwan Kim and explained the purpose of today’s visit. The facility is licensed to operate for (6) non-ambulatory elderly residents ages 60 and above. The facility is approved for (1) hospice resident. There are currently five (5) residents in care.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: six (6) resident's rooms, six (6) bathrooms, a living area, a dining area, a kitchen, and outside patio area.

LPM & LPA toured the physical plant .All rooms were inspected. Beds and bedding supplies were in good condition, lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels stocked at the time of visit. Bathrooms were operational. The water temperature measured 118.6 F. A comfortable temperature of 74 degrees was maintained in the facility.

LPA observed the facility to be furnished at the time of visit. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. The facility has (2) fire extinguisher that is charged, smoke detectors operable. A working landline telephone remains available. The facility maintains 2 days of perishable and 7 days of non-perishable food supplies.

Due to lack of time an unannounced continuation of this visit will be conducted.

No deficiencies were cited. An exit interview was conducted. A copy of this report was provided to Ki H. Kim, Administrator.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Socorro LeandroTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2023
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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