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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320197
Report Date: 05/15/2023
Date Signed: 05/15/2023 04:03:15 PM


Document Has Been Signed on 05/15/2023 04:03 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:PLAZA AT WESTWOOD, THEFACILITY NUMBER:
198320197
ADMINISTRATOR:VIRGINIA ZENTENOFACILITY TYPE:
740
ADDRESS:2228 WESTWOOD BLVDTELEPHONE:
(323) 217-7877
CITY:LOS ANGELESSTATE: CAZIP CODE:
90064
CAPACITY:136CENSUS: 62DATE:
05/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:36 AM
MET WITH:Virginia ZentenoTIME COMPLETED:
03:30 PM
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On 05/15/23, Licensing Program Analyst (LPA), Wendy Gibbs conducted an unannounced annual visit at the facility listed above. LPA met with Administrator Virginia Zenteno, and explained the purpose of todays visit. The facility is licensed for 136 residents, 136 non-ambulatory, of which 6 can be bedridden and 12 hospice waivers. Currently there are 62 residents, 18 are non-ambulatory, 4 are bedridden, and 3 are on hospice care.
Structure/Physical Plant: The facility is a three-story building with 68 resident-bedrooms, and 74-bathrooms. 1st floor consists of a lobby area, laundry facility, staff break room and an adjacent parking structure. 2nd floor consists of residential rooms, dining room, kitchen, outdoor patio, media room and medication room. The 3rd floor consists of resident rooms and storage. There is a shaded patio / courtyard area with tables and chairs. Shaded area has sufficient tables and chairs for residents. Outdoor passageways, walkways, driveways, steps, and patios are free from obstructions, hazards, or debris. LPA did not observe any bodies of water on the premises.
Bedrooms During today's visit, LPA inspected rooms 202, 229, 230, 330, 329, and 326. The Resident bedrooms are spacious and easily accommodate furnishings. All bedrooms were observed to have the required furniture including a bed(s), dresser(s), nightstand(s), lighting, chair(s), and ample storage space resident’s personal belongings.
Bathrooms: Facility has approx. 74 bathrooms (68 full baths and 6 half). Bathrooms were observed to have a working toilet, wash basin and shower. All handrails were securely attached. LPA observed a non-skid mat and chair in showers. The water temperature measured between 107.2-degrees and 113.1-degrees Fahrenheit.
Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheets, blanket and bedspreads. LPA observed an ample supply of linens including sheets, pillowcases, bath towels in a storage room. Facility does not provide hygiene supplies to residents.

Report Continued on LIC809-C
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy GibbsTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2023
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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: PLAZA AT WESTWOOD, THE
FACILITY NUMBER: 198320197
VISIT DATE: 05/15/2023
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Kitchen LPA inspected the kitchen. During today’s inspection, LPA observed all appliance to be in good working order including stove burners, oven, microwave, freezer, and refrigerator. The refrigerator and freezer are maintained at the correct temperate for food storage. LPA observed all cutleries, pots, and pans to be in good repair. All sharps are secured in locked drawer in the kitchen. LPA observed a 3-day supply of perishable and a 7-day supply of non-perishable foods. All food was observed to be properly stored and labeled.
Common Rooms LPA inspected all common rooms. In the dining room LPA observed ample seating to accommodate residents. A menu was posted at the entrance of the dining room and at the tables. LPA observed residents playing bingo in the activity room. The facility has board games, books, and other recreational materials for the client's use as well as an activity calendar. Residents are provided with a monthly activity calendar, and they are posted by the elevator on all floors. LPA observed all hallways, walkways, to be clean, clear, and free of obstructions or hazards. The facility was maintained at a comfortable temperature.
Safety LPA observed multiple fully charged fire extinguishers mounted throughout the facility last serviced on 01/31/23. The backup generator is ran weekly and was last inspected by Los Angeles Fire Department (LAFD) on 03/31/23. The dual smoke/carbon monoxide detectors are hardwired and interconnected were operational and linked to LAFD. The system was last inspected and tested on 01/31/23 by LAFD. The last emergency drill was conducted on 02/21/23 (day shift), 03/02/23 (evening Shift), and 03/03/23 (night shift). The elevator was last inspected on 03/29/23. All exits are clearly marked, and facility sketches are posted throughout the facility. LPA observed an Emergency Disaster Plan (LIS610E), and Emergency Agency Numbers posted. The First Aid Kit was inspected and contained the required items and a manual. LPA tested the landline and found it to be fully operational. All toxins and cleaning supplies are secured in a locked storage room on the 1st floor and are inaccessible to residents.
Medications LPA observed all centrally stored medication to be in their original packaging. LPA reviewed the medications and MARs for 6 residents. All medications are secured in the Medication Room and are locked in a med cart.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy GibbsTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023
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: PLAZA AT WESTWOOD, THE
FACILITY NUMBER: 198320197
VISIT DATE: 05/15/2023
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Document Review/Interviews: LPA reviewed the files for 5 residents and found they contained the required documents. LPA interviewed 5 residents and found they were happy with the services and care they receive from the facility. LPA reviewed 5 staff and Administrator files and found they contained the required documents, clearance, certification, and training. LPA interviewed 5 staff and all staff were able to explain policy, procedure, and resident’s personal rights. LPA reviewed and received copies of Liability Insurance, current Fire Protection Equipment Performance Report, Staff and Resident Roster, Resident Council Rights and notes, Personal Rights posting, Theft and Loss Policies postings, and Resident Admission Packet.

Infection Control During today’s visit, LPA observed the facility’s Infection Control Policies. LPA conducted a risk assessment before entering the facility to ensure it is Covid-19 free. Upon entry LPA observed a sanitizing station and Visitor and Resident Log sheets. All visitor’s temperature is taken and documented. LPA observed required Infection Control postings throughout the facility. LPA observed an ample supply of sanitizer, hand soap, and paper towels. LPA observed a 90-day supply of PPEs secured and stored in a storage room. LPA observed all staff to be wearing face coverings.


LPA did not observe any deficiencies during today’s visit.

An exit interview was conducted with Administrator, Virginia Zenteno and a copy of this report was provided.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy GibbsTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2023
LIC809 (FAS) - (06/04)
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