198320280-11-6-2023-11-AS-RCLD-CXBVSG-20231106154131

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320280
Report Date: 11/06/2023
Date Signed: 11/06/2023 03:41:56 PM

Document Has Been Signed on 11/06/2023 03:41 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	TORRANCE REGENCY SENIOR LIVING II		FACILITY NUMBER:	198320280
ADMINISTRATOR:	TAPORCO, ROBIN S.		FACILITY TYPE:	740
ADDRESS:	22549 S. VAN DEENE AVE.		TELEPHONE:	(408) 916-7347
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90502
CAPACITY:	6	CENSUS: 6	DATE:	11/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Robin Taporco and Jerissa Bucu		TIME COMPLETED:	03:50 PM

NARRATIVE

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On 11/062023 at 8:50 AM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Robin Taporco, Licensee and Jerissa Bucu, Administrator. Six (6) residents and two (2) caregivers were present during this inspection.

The facility is licensed to serve five (5) non-ambulatory residents and one (1) bedridden in room one. The facility also has an approved hospice waiver for four (4) residents. Two residents are receiving hospice services and two residents are receiving home health services.

The home one floor and consists of: four (4) resident rooms, two (2) bathrooms, kitchen, dining room, living, indoor ramp, shaded patio and a laundry room near one of the bathrooms.

Staff accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards.

Resident bedrooms had the required bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises.

Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked.

Common areas were clean and clear of hazards, doorways were free of obstructions.

LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxics were kept in locked storage cabinet. First Aid kit was available. One fire extinguisher, last serviced February 16, 2023 was observed in the kitchen area. LPA tested interconnected smoke detector throughout the facility. Devices are functional.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023

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 ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: TORRANCE REGENCY SENIOR LIVING II	FACILITY NUMBER: 198320280
	VISIT DATE: 11/06/2023

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A copy of the video surveillance addendum and updated facility sketch was reviewed.

Six staff records were reviewed, six out of six staff records had required criminal record clearances. Training records were reviewed. Two staff members were interviewed.

Five resident records were reviewed, and five out of five resident records had Admission Agreements, Medical Assessments, Pre-appraisals (or Reappraisals) and/or Needs & Services Plans. Hospice and Home Health Records were reviewed. Two medication records were reviewed. Two residents were interviewed.

At 9:30 AM LPA tested water temperatures in both bathrooms. The shower temperature in the bathroom across from room 2 measured at 121 degree F and the water basin at 123 degree F. The shower temperature near room 4 was measured at 122 degree F and the water basin at 122.3 degree F. LPA informed the Licensee and Administrator of the required temperature range (105 – 120 degree F) and an immediate on-site correction was made.

Deficiencies are being cited based on LPA observation in accordance with the California Code of Regulations, Title 22, see LIC809D.

An exit interview was conducted, technical assistance provided, and plan of correction was developed and reviewed with the Jerissa Bucu. A copy of this report and appeal rights were discussed and left with the Administrator.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/06/2023 03:41 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 ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: TORRANCE REGENCY SENIOR LIVING II	FACILITY NUMBER: 198320280
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87303(e)(2)

Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). 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 in two out of two bathrooms which posed a potential health and safety risk to persons in care.
	POC Due Date: 11/07/2023
	Plan of Correction
1 2 3 4	The Licensee and Administrator immediately adjusted the water heater during this inspection. The Administrator will test and document the water temperature monthly.

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: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023

LIC809 (FAS) - (06/04)

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