198320184-2-8-2023-11-AS-WGIS-CNL2RU-20230130163807

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320184
Report Date: 01/30/2023
Date Signed: 02/08/2023 05:07:40 PM

Document Has Been Signed on 02/08/2023 05:07 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	AVENIR MEMORY CARE WESTSIDE		FACILITY NUMBER:	198320184
ADMINISTRATOR:	DRINKHOUSE-QUINTA, MARISSA		FACILITY TYPE:	740
ADDRESS:	7501 OSAGE AVE		TELEPHONE:	(424) 282-0040
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90045
CAPACITY:	88	CENSUS: 28	DATE:	01/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:26 PM
MET WITH:	Jodi Kanowitz		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 1/30/23, Licensing Program Analyst (LPA), Wendy Gibbs conducted an unannounced annual visit. Upon arrival at the facility, LPA Gibbs called and conducted a risk assessment. LPA met with Administrator, Judy Kanowitz, and the purpose of this visit was explained. Structure: The facility is a two-story commercial building located in a business and residential neighborhood which consisted of the following: There is a hand washing station, reception area, check-in station, lobby, cameras in common areas, 48 resident rooms to accommodate 88 residents all resident rooms have a private bathroom, 7 public restrooms, living/family rooms, commercial kitchen; 2 bistro kitchens, dining rooms, staff lounge, mechanical room, maintenance room, nurses’ stations, conference room, offices, medication rooms, sitting areas, activity room, media lounge, physical therapy room, solarium room, salon, locked supply closets, locked laundry rooms, shaded areas, courtyards, indoor/outdoor activity areas, and a parking lot. Physical Plant LPA, Administrator and Plant Operations Director, Robert Gardcia Jr. toured the facility inside and out. The front and back were landscape and in excellent condition at the time of the visit. All patios have table, chairs and umbrellas. Two of the patios are used for outdoor activities and have games set up. LPA was informed that the generator is tested weekly. All walkways are clean and clear of hazards, obstructions and debris. LPA did not observe any bodies of water. Residents Bedrooms: Bedrooms #1-48 are designated as resident's bedrooms. The bedrooms have twin-size beds, chairs, nightstand, lamp, custom closet equipped with storage drawers, drawer space, and sufficient lighting for each resident.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: AVENIR MEMORY CARE WESTSIDE	FACILITY NUMBER: 198320184
	VISIT DATE: 01/30/2023

NARRATIVE

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Bathrooms: The bathrooms floors are clean, sanitary, and odorless. There are working toilets, sinks, and showers in all the bathroom. All showers have secured grab bars, shower chairs, non-skid materials in the shower, and closed lid trash cans. LPA observed an ample supply of hand soap and paper towels. Water temperature measured between 105.1- through 107.3- degrees Fahrenheit.
Linens & Hygiene Supplies: All beds had the required linens including pillowcases, mattress paddings, fitted sheets, blankets, and comforters/bedspreads. An adequate supply of linens is kept in the housekeeping room. Hygiene supplies are stored in the resident’s locked bathroom cabinets.
Toxins: Cleaning supplies and toxins are stored in a locked supply closet located on the first and second floor in housekeeping and only accessible to staff.
Food Service: The facility has an industrial kitchen. The kitchen was clean and free of debris. All appliances were in good repair. All dishes, cups, and flatware are stored in the kitchen cupboards, inspected, and in good repair. LPA observed a 7-day supply of nonperishable foods and a 3-day supply of perishable foods. LPA observed a 10-day supply of water and nonperishable foods stored for an emergency. The kitchen is locked and inaccessible to residents. A menu is posted on the wall near the dining room and in the kitchen, they have their resident’s special dietary needs posted.
Common Rooms There are multiple sitting and television viewing area available for residents. There is ample seating for all residents. There is a dining area upstairs and downstairs that have ample seating for all residents. All walkways are clean and clear of hazards, obstructions and debris. During visit, LPA observed residents engaged in an activity in one of the activity rooms.
Medications: All medications are stored in the locked medicine room on the second floor. LPA reviewed, five (5) resident’s medications and matched them to the MARs, reviewed the medication narcotics storage and matched them to the MARs and reviewed the refrigerated medications. All medications are inaccessible to residents.
Files: LPA reviewed five (5) resident files and found they contained all the required documentation. LPA reviewed three (3) staff files and found they contained all the required documentation, training and certification.
Safety There are hardwire smoke alarms and carbon monoxide detectors located on each floor throughout the facility that is operational. There is a fire sprinkler system throughout the facility. They are both serviced annually. There are (12) fully charged fire extinguishers located throughout the facility. All emergency numbers are posted. Emergency drills are done monthly. The facility has a working landline.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023

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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: AVENIR MEMORY CARE WESTSIDE	FACILITY NUMBER: 198320184
	VISIT DATE: 01/30/2023

NARRATIVE

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Infection Control LPA was properly screened for COVID-19 symptoms and temperature was checked. LPA observed a sanitizing station at the entrance; visitors log with COVID-19 screening and temperature log, and records of daily COVID-19 screening and temperature checks. PPE supplies are readily available to staff, and an additional 60-day supply of PPEs is stored in the storage room; sufficient paper, cleaning, and disinfecting supplies were observed. All staff were wearing a mask. Posting were viewed throughout the facility.

LPA viewed the Liability Insurance.

No deficiencies were cited today.
An exit interview was conducted with Administrator and a copy of this report was provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023

LIC809 (FAS) - (06/04)

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