198320203-9-14-2023-11-AS-WGIS-CVNTC6-20230914143609

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320203
Report Date: 09/14/2023
Date Signed: 09/14/2023 02:36:18 PM

Document Has Been Signed on 09/14/2023 02:36 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:	ADORABLE REDBEAM HOME		FACILITY NUMBER:	198320203
ADMINISTRATOR:	LINAYAO, KADIGUIA O.		FACILITY TYPE:	740
ADDRESS:	22521 REDBEAM AVE.		TELEPHONE:	(424) 777-8707
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90505
CAPACITY:	6	CENSUS: 5	DATE:	09/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Kadiguia Linayao		TIME COMPLETED:	02:30 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 09/14/23, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced annual visit using the full CAREs tool. LPA met with Administrator, Kadiguia Linayao, and explained the purpose of today's visit. The facility currently has five (5) residents, two (2) who are receiving Hospice Care. Structure/Physical Plant The facility is a single-story home in a residential neighborhood. It consists of 4 resident bedrooms, 3 bathrooms, kitchen, dining room, living area, outside shaded patio and attached garage. LPA and Administrator toured the facility. The front and backyard are landscaped and maintained. All walkways on the outside of the home were observed clean, clear, and free of obstructions, debris, and hazards. All gates exiting the backyard open easily. LPA did not observe any bodies of water on the premises. Bedrooms LPA inspected all resident bedrooms. All bedrooms were observed to have the required furniture including bed(s), nightstand(s) with lamps, dresser(s), chair(s), and adequate storage space for personal belongings. All beds had the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillows. LPA observed an ample supply of bed linens in good repair. Bathrooms LPA inspected all bathrooms. Bathrooms were found to be within Title 22 regulation and were observed to be clean and operational. All bathrooms had nonskid matts and a shower chair available. The safety grab bars are secured to walls. LPA observed an ample supply of towels and hygiene products available for residents. The water temperature measured 120.4-degrees, 124.3-degrees, and 123.3-degrees Fahrenheit. LPA observed an ample supply of incontinent care supplies stored in resident rooms and an additional supply stored in the garage. Kitchen LPA inspected the kitchen and found it to be clean and sanitary. All appliances were observed to be in good working repair. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable. LPA observed an ample supply of cutleries, pots, and pans in good repair. All sharps are secured in a locked drawer and are inaccessible to residents. All cleaning supplies are stored under the sink and are inaccessible to residents. The water temperature measured 123.4-degrees Fahrenheit.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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: ADORABLE REDBEAM HOME	FACILITY NUMBER: 198320203
	VISIT DATE: 09/14/2023

NARRATIVE

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Common Rooms LPA inspected all common rooms. The living areas had ample seating for all resident. Puzzles, games, and activities were observed in the living room and dining room. The dining room has a large rectangular table and chairs to accommodate all residents. LPA observed a fireplace that was screened and inaccessible to residents. All walkways were observed to be clean, clear, and free of obstructions and hazards. All rooms were maintained at a comfortable temperature. All rooms were observed to have ample lighting.
Medications LPA reviewed the medications, Medication Administration Record (MAR), and medication destruction log for three (3) resident's. Three out of three resident’s MARs and medication are consistent with properly documented records. All medications were observed in their original containers. Centrally stored medications were observed secured in a locked cabinet in the office area.
Safety LPA observed a fully charged fire extinguisher, mounted on the wall at the kitchen entrance, last serviced on 12/21/22. The last emergency drill was conducted on 08/19/23. Smoke detectors and carbon monoxide detectors are operable. The facility has a working landline telephone. LPA observed all required signs and documents posted throughout the facility. LPA inspected the First Aid kit and found it had the required items.
File Review & Interviews LPA reviewed all resident files and found they contained the required documents. LPA interviewed three residents and three out of three residents said they were happy with the care and services they receive. LPA reviewed the Administrator and three (3) staff files and found they contained the required training, certification, and documents. LPA interviewed the Administrator and two (2) staff who were able to explain procedures, care, and personal rights of Residents.
Infection Control During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed all required Infection Control postings throughout the facility. LPA observed all staff were wearing a face mask. LPA observed a 60-day supply of PPEs stored in the garage.

Deficiency: Based on observation, LPA tested the water temperature in the bathrooms and kitchen and they measured between 120.4-degrees and 124.3-degrees Fahrenheit. Administrator changed the temperature during visit and temperature was retested and measured 115.0-degrees Fahrenheit.

An exit interview was conducted with Administrator Kadiguia Linayao, and a copy of this report, and appeals rights were provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3

Document Has Been Signed on 09/14/2023 02:36 PM - It Cannot Be Edited

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: ADORABLE REDBEAM HOME	FACILITY NUMBER: 198320203
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87303(e)(2)

87303 Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regualte the temperature of hot water used by residents to attain a temperature of not less than 105-degrees F and not more than 120-degrees F. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above, LPA tested the water temperature in the bathrooms and kitchen and the temperature measured 120.4-, 123.3-, 124.3-, and 123.4-degrees F, which posed a potential health, and safety risk to persons in care.
	POC Due Date: 09/14/2023
	Plan of Correction
1 2 3 4	Administrator changed the temperature on the water heater during visit. LPA retested the temperature and the new temperature measured 115.0-degrees F.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

LIC809 (FAS) - (06/04)

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