198320280-5-17-2024-11-AS-JCAN-D5BTFC-20240516144119

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320280
Report Date: 05/16/2024
Date Signed: 05/17/2024 07:53:06 AM

Document Has Been Signed on 05/17/2024 07:53 AM - 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:	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: 5	DATE:	05/16/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:52 AM
MET WITH:	ADMINISRATOR JERISSA BUCU		TIME COMPLETED:	03:30 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 05/16/2024 at 12:00 NOON, Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced annual inspection visit at the Torrance Regency Senior Living Facility 2. LPA Calderon was allowed entry into the facility by Administrator Jerissa Bucu. Administrator Jerissa Bucu asked infection control questions and took LPA Calderon temperature prior to entrance into the facility. The facility is licensed to serve five (5) non-ambulatory residents. 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. Currently, there are (5) residents residing in the facility with health issues. LPA Calderon explained to Administrator Jerissa Bucu, the purpose of the one-year Annual Inspection visit, and escorted LPA Calderon on a tour of the entire inside and outside facility grounds. As part of the inspection, LPA Calderon reviewed: (5) resident service records, (5) resident medication records, (3) staff records, and inspected the inside facility and outside grounds. LPA Calderon interviewed (5) residents and (3) staff members for visit. The facilities’ last fire drill was conducted on 05/06/2024. The one-story residential home consists of (4) resident bedrooms, (2) resident bathrooms, living room, dining room, kitchen, staff room, office area, attached garage with washer and dryer/ storage area, backyard with table and chairs. No weapons are stored in the premises. Kitchen was inspected and observed to be clean and operational. A two-day supply perishable and seven-day supply of non-perishable foods are present in the facility. Emergency Water Storage is found in the garage.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

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: TORRANCE REGENCY SENIOR LIVING II	FACILITY NUMBER: 198320280
	VISIT DATE: 05/16/2024

NARRATIVE

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LPA Calderon observed that all facility rooms are clean and in good repair. A comfortable temperature was observed, and the facility has central air and heating. LPA Calderon observed the following during inspection of resident’s rooms: mattresses are in good condition, adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. All bedrooms contain furniture, lighting fixtures and personal storage space as required, all beds have the required amount of linen and mattress covers, LPA Calderon observed fully stocked closet with bedding, towels, and toiletries supplies. Bathroom fixtures are clean, in good repair, and working properly and contain the required nonskid mats and grab bars. LPA Calderon observed bathrooms were found to be within Title 22 regulation. Bathroom #1 hot water temperature properly measured at 110 degrees Fahrenheit, and bathroom #2 hot water temperature properly measured at 109 degrees Fahrenheit. Kitchen hot water temperature properly measured at 113 degrees Fahrenheit. Facility (5) Carbon Monoxide and (5) Smoke Detectors hard wired and connected were tested and are working properly. The facility (1) Fire Extinguishers were checked and found to be fully charged and accessible. All exit doors in the facility have alarm systems. All toxins and knifes are locked/secured and inaccessible to residents. Medications are centrally stored and in a locked storage cabinet. Facility first aid kit is fully stocked with manual was checked and in order. Outside grounds were toured and no bodies of water were observed. All Exits/ Walkways around the home were free of debris and hazards. Outside patio accessible to residents. Three resident files were reviewed and found to be complete. LPA Calderon reviewed (5) resident medications and they were all found to be administered according to doctor's orders. Three staff files were checked and have the required documents. LPA Calderon noted the Administrator Jerissa Bucu Certification # 6007465740 expiration date of 11/10/2025 was valid at time of visit. The facility does NOT handle resident's money/cash resources and no Surety bond is needed. Commercial General Liability Policy #PC17897835601 policy period from 08/16/2023 to 08/16/2024 underwritten by Primary Care Insurance Company, coverage 1,000,000/3,000,000 is valid at time of inspection. LPA Calderon spoke to Administrator Jerissa Bucu who will email full copy of insurance contact which shows all coverages to LPA Calderon on 05/26/2024. All the required documents are posted in the facility in a clearly visible area.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

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: TORRANCE REGENCY SENIOR LIVING II	FACILITY NUMBER: 198320280
	VISIT DATE: 05/16/2024

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During the visit, LPA Calderon observed the facility infection control practices. LPA Calderon observed screening protocols for visitors, staff, and residents, sanitizing stations (Located in common areas and restrooms). LPA Calderon observed staff and residents were NOT wearing face coverings. LPA Calderon observed the facility has a thirty-day supply of Personal Protective Equipment (PPE).

LPA Calderon advised the Administrator Jerissa Bucu to continuously monitor the Centers for Disease Control (CDC) website and Community Care Likening Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA Calderon did not observe deficiencies therefore no citations were issued at this time. Annual Licensing Fee is CURRENT An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Administrator Jerissa Bucu.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

LIC809 (FAS) - (06/04)

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