198320197-5-30-2024-11-AS-SDAY-D5RTFS-20240530144201

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320197
Report Date: 05/30/2024
Date Signed: 05/30/2024 02:42:09 PM

Document Has Been Signed on 05/30/2024 02:42 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME:	PLAZA AT WESTWOOD, THE		FACILITY NUMBER:	198320197
ADMINISTRATOR:	LUZ EMMA ROSE		FACILITY TYPE:	740
ADDRESS:	2228 WESTWOOD BLVD		TELEPHONE:	(310) 475-8861
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90064
CAPACITY:	136	CENSUS: 58	DATE:	05/30/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Luz Emma Rose		TIME COMPLETED:	03:00 PM

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Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one-year inspection. LPA met with Luz Emma Rose, Administrator and the purpose of the visit was discussed. Facility is licensed to serve 136 non- ambulatory residents of which 6 may be bedridden. The facility has an approved hospice waiver for 12 residents. Currently(4) residents or on hospice, (2) residents have dementia and (7) are receiving Home health services. The facility does not handle any of the residents’ money.

LPA and Administrator toured the facility @ approximately 1:00pm

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 , hair salon and an adjacent parking structure. The 2nd floor and 3rd floor consists of residential rooms. The 2nd floor also consists of the dining room, kitchen, outdoor shaded patio,courtyard area with tables and chairs, Activity room and medication room and Administrator office. The 3rd floor consists of resident rooms and storage. 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 203, 206, 211, 337, 342, 332 and 322. The Resident bedrooms are spacious and easily accommodate furnishings. All bedrooms were observed to have the required furniture per Title 22..

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 108 degrees and 115-degrees Fahrenheit

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Sparkle Day	TELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024

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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: PLAZA AT WESTWOOD, THE	FACILITY NUMBER: 198320197
	VISIT DATE: 05/30/2024

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Linens & Hygiene Supplies: LPA observed an ample supply of linens including , and hygiene supplies for residents
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 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. There is a backup generator. The dual smoke/carbon monoxide detectors are hardwired and interconnected were operational and linked to LAFD. The system was last inspected and tested on 3/16/24 by LAFD. All required documents are posted according to Title 22. 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 1^st floor and are inaccessible to residents.
At approximately 11:00 am LPA observed all centrally stored medication to be in their original packaging. LPA reviewed the medications and MARs for 10 residents. All medications are secured in the Medication Room and are locked in a med cart. LPA reviewed the files for 10 residents and 5 staff and found they contained the required documents. LPA interviewed 5 residents and 7 staff.
According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies, therefore no citations issued at this time.

An exit interview was conducted and a copy of the Facility Evaluation Report was provided to the Administrator Luz Rose..

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Sparkle Day	TELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024

LIC809 (FAS) - (06/04)

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