198320179-7-16-2021-11-AS-TAGD-C4YU6A-20210716151800

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320179
Report Date: 07/16/2021
Date Signed: 07/16/2021 03:18:52 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:	198320179
ADMINISTRATOR:	MALONE, JASON		FACILITY TYPE:	740
ADDRESS:	201 NORTH CRESCENT DRIVE		TELEPHONE:	(310) 274-4479
CITY:	BEVERLY HILLS	STATE: CA	ZIP CODE:	90210
CAPACITY:	127	CENSUS: 57	DATE:	07/16/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Jason Malone		TIME COMPLETED:	03:17 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	Licensing Program Analyst (LPA) Agard, conducted an announced visit to the facility for the purpose of a Change in Ownership pre-licensing evaluation. An application was submitted to CCLD on 01/21/2021, for a change in ownership for a Residential Care Facility for the Elderly to serve individuals ages 60 years and older. The requested capacity is for 127 of which 118 can be non-ambulatories and 9 can be bedridden. Facility is approved for 20 hospice residents. Structure: Facility has 80 units, and approximately 86-bathrooms, is five stories tall with a basement garage. The facility is a beige in color structure with a gym/ physical therapy room, bistro, formal dining room, theater, a restaurant style kitchen, and two elevators. There is a large patio area on the 3^rd floor and other sitting areas on the 1^st floor. The resident bedrooms are spacious and will easily accommodate the furnishings. All walkable areas were observed clear and free of any hazards. Bedrooms: There shall be no more than two residents per bedroom. All Bedrooms are approved for non-ambulatory residents. Facility does not provide furnishings for all residents’ bedrooms but does offer rental services for residents that wish to have a pre-furnished room. Bedrooms are large enough to accommodate furnishings. Bathrooms: All bathrooms have a working toilet, wash basin, bathtub/shower. There are approximately 6 half baths in the common area. LPA observed bathrooms that will accommodate non-ambulatory clients in a wheelchair. Linens & Hygiene Supplies: LPA observed a stage bedroom with the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Facility generally does not provide linen or hygiene supplies unless

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021

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: 198320179
	VISIT DATE: 07/16/2021

NARRATIVE

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requested.

Emergency Phone Numbers, Exit Plan & Menu:
Facility has a dedicated landline. LPA observed a fire extinguisher located in the kitchen mounted on the wall, and several others observed throughout the facility.

Food Service:
Dishes, cups and flat ware are stored in the kitchen. LPA observed staged dish/flatware that were in good repair. Knives, cutlery and other sharp kitchen utensils are stored inaccessible to the residents in care. Food supply adequate and stored in kitchen and consists of more than 2 days’ worth of perishable and 7 days’ worth of non-perishables. A variety of food options was observed on a menu in the dining room.

Smoke Detectors:
Electrical & connected. Carbon monoxide detectors operational. Fire inspection was conducted on 04/13/2021

Appliances:
Stove burners, oven, microwave, washer, and dryer are in working order. There is one large refrigerator, and freezer in the kitchen. Each set at an appropriate temperature for food storage. The residence is equipped with central air and heat and each resident bedroom is individually climate controlled.

Toxins:
Locked/stored

Water Temperature:
Tested at 113 degrees.

Medications, First-Aid Kit & Book:
A first aid kit is available which has at least the following items: thermometer, tweezers, scissors, antiseptic, bandages, gauze and current first aid manual, which are stored and available for staff use but inaccessible to residents.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021

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: 198320179
	VISIT DATE: 07/16/2021

NARRATIVE

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Resident & Staff Files:
Staff and resident files are stored digitally /or hard copy in Administrative office’s and inaccessible to other staff and residents. Facility does not manage residents’ funds.

Reading Material, Games, Equipment & Materials:
The facility has board games, books, and other recreational materials for the resident’s use, commensurate with the plan of operation.

Pool/Jacuzzi & Pets:
None.

Fire clearance:
Facility has been cleared with the following special conditions, approved on 04/13/2021. A capacity of 127 residents of which 118 can be non-ambulatory and 9 can be bed-ridden.

Component III:
Conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance was done for SUNRISE OF BEVERLY HILLS on 07/16/2021

An exit interview was conducted, and a copy of this report has been furnished to the applicant representative. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to their application.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021

LIC809 (FAS) - (06/04)

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