198320199-10-16-2024-11-AS-DLEE-DA4S4B-20241016133229

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320199
Report Date: 10/16/2024
Date Signed: 10/16/2024 01:32:53 PM

Document Has Been Signed on 10/16/2024 01:32 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:	KEEN HOME LONG BEACH		FACILITY NUMBER:	198320199
ADMINISTRATOR:	ADRIEN HERBAS		FACILITY TYPE:	740
ADDRESS:	6441 E BIXBY HILL RD		TELEPHONE:	(562) 438-5336
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90815
CAPACITY:	6	CENSUS: 6	DATE:	10/16/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:04 AM
MET WITH:	Ginny Dutile, Administrator		TIME COMPLETED:	02:00 PM

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On October 16, 2024, Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced required annual visit using the CARE Inspection Tools. LPA met with Aurora Ortiz, Lead Staff and explained the purpose of this visit. Subsequently Administrator Ginny Dutile arrived and assisted with the visit. The facility is licensed to operate for (6) Bedridden elderly residents ages 60 and above and has an approved hospice waiver for (6); There are currently 6 residents in care--none of which are currently bedridden.

Structure This facility consists of six (6) resident bedrooms, three (3) full bathrooms and 1/2, kitchen, living room/TV room, receiving room, dining area, shaded patio, and a garage which serves as an office/storage space. Operable smoke detectors/carbon monoxide throughout facility were observed. Two fire extinguishers last serviced on 02/05/2024 are in the kitchen and hallway. The last facility fire drill was on 08/22/2024

Physical Plant LPA and Ginny Dutile toured the facility inside and outside. LPA observed there were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident's personal belongings was observed. LPA observed that facility had required postings: ombudsman poster, see something say something poster, clients rights, infectious disease postings, activities calendar and facility sketch.

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SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Deborah Lee	TELEPHONE: (424) 544-1051
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024

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: KEEN HOME LONG BEACH	FACILITY NUMBER: 198320199
	VISIT DATE: 10/16/2024

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Bedrooms LPA inspected all six (6) bedrooms. All bedrooms were observed to have the required furniture including beds, dressers, nightstands with lamps, chairs, and ample storage space for personal belongings. All bedrooms were observed to be clean, in good repair, and have ample lighting.

Bathrooms LPA inspected the facility bathrooms. In the resident’s bathroom the toilet, faucets, and shower were fully operational. All safety handrails were securely fastened. LPA observed the showers to be clean and free of mold or mildew. The shower had a nonskid material in bottom and shower chair. LPA observed area where residents toiletries are kept. The water temperature measured 112-degrees Fahrenheit. The toilet and faucets are operational. Both bathrooms were observed to be clean, in good repair and within Title 22 regulations.

Linens & Hygiene LPA observed all beds to have the required linens including mattress cover, fitted sheets, blanket, comforter, and pillow. LPA observed an ample supply of linens, towels, and blankets in the hall closets.

Kitchen/Laundry Room LPA inspected the kitchen and observed all appliances to be in good working repair, including stove/oven, microwave, dishwasher, washer, dryer, refrigerator, and additional freezer. LPA observed an ample supply of cutleries, pots, pans, and bowls to be in good repair. LPA observed knives and additional sharps to be secured in locked cabinet in the kitchen and are inaccessible to residents. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods. Cleaning products and toxins were secured in closet that is inaccessible to clients.

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SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Deborah Lee	TELEPHONE: (424) 544-1051
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024

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: KEEN HOME LONG BEACH	FACILITY NUMBER: 198320199
	VISIT DATE: 10/16/2024

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Common Rooms In the living room, LPA observed 2 recliners 2 chairs sofa mounted TV. In the dining room, LPA observed a six seated dinning table and large kitchen counter separating dinning area from kitchen. There is a "den" area with mounted TV and adequate seating: 4 recliners.

Medications LPA observed all centrally stored medications in their original packaging and are secured in a locked closet that is inaccessible to Residents in care.

Files LPA reviewed (6) resident files and found they contained all the necessary documentation. LPA reviewed four (4) staff files and found they contained the required documentation, certification, and training. Liability Insurance expires on 8/6/2025.

Infection Control During the visit, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance. PPE supplies are readily available to staff, and an additional 30-day supply of PPE was observed. Sufficient paper towels, cleaning, and disinfecting supplies were observed and stored in garage area.

There were no deficiencies cited during today’s visit.

An exit interview was conducted with Ginny Dutile, Administrator. A copy of this report was given to Administrator.

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SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Deborah Lee	TELEPHONE: (424) 544-1051
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024

LIC809 (FAS) - (06/04)

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