198320185-5-17-2023-11-AS-PSCT-CRWRA8-20230517125043

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320185
Report Date: 05/17/2023
Date Signed: 05/17/2023 12:50:48 PM

Document Has Been Signed on 05/17/2023 12:50 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:	SWEET LIFE SENIOR CARE		FACILITY NUMBER:	198320185
ADMINISTRATOR:	TAPORCO, ROBIN		FACILITY TYPE:	740
ADDRESS:	23741 KIPPEN ST		TELEPHONE:	(424) 263-4677
CITY:	HARBOR CITY	STATE: CA	ZIP CODE:	90710
CAPACITY:	6	CENSUS: 6	DATE:	05/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Robin Taporco		TIME COMPLETED:	01:00 PM

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On 05/17/2023 at 9:20 am, Licensing Program Analyst (LPA) Perry Scott conducted an unannounced annual required visit using the new CARE Inspection Tool. LPA was met by Licensee, Robin Taporco, and later by Administrator, Jerissa Bucu, and the purpose of today’s visit was explained. The facility is licensed to serve six (6) non-ambulatory elderly residents ages 60 and above; of which one (1) can be bedridden in room #4 and has a hospice waiver for four (4). Currently, the home has (6) residents. The facilities annual fees are current.

The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident's rooms, two (2) bathrooms, living area, dining area, kitchen, and outside shaded patio area.

LPA and Licensee toured the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were operational. The water temperature measured 113.5 F within title 22 regulations. There is an attached garage used for storage only. The garage contains additional food supplies, additional refrigerator/freezer for food, and a washer and dryer.

LPA conducted a records review of (6) residents records, (6) staff records, and reviewed the facility disaster plan. All resident & staff records were complete. The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (6) Client Medication Administration Records and did not observe any discrepancies at the time of visit.

Report continued on LIC809-C

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

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: SWEET LIFE SENIOR CARE	FACILITY NUMBER: 198320185
	VISIT DATE: 05/17/2023

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LPA observed the facility to be appropriately furnished at the time of visit. LPA observed sharps, cleaning supplies and toxins in locked cabinets. The kitchen was inspected and there is sufficient perishable and non-perishable food available and properly maintained. The facility does their grocery shopping every week for food. One (1) fire extinguisher was charged and located in the kitchen area, smoke detectors and carbon monoxide were operable. A review of Medication Administration Records (MAR) was maintained in order and accurate. There was a first aid kit available located with the medications. The last fire/emergency drill was conducted on 05/12/2023.

During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents. Sanitizing stations (Located in common areas and restrooms) were stocked with masks, gloves, and sanitizers. LPA observed staff were wearing face coverings and LPAs temperature was taken upon entry. LPA observed the facility to have a 60-day supply of Personal Protective Equipment (PPE).

LPA advised the Administrator to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing (www.cdss.ca.gov ) for Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance and other advisories.

During today’s visit there were no deficiencies observed.

An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Administrator, Jerissa Bucu.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

LIC809 (FAS) - (06/04)

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