198320315-12-7-2022-11-AS-JCAN-CLVQTP-20221207112729

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320315
Report Date: 12/07/2022
Date Signed: 12/07/2022 11:27:52 AM

Document Has Been Signed on 12/07/2022 11:27 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	LAUREL AT LONG BEACH, THE		FACILITY NUMBER:	198320315
ADMINISTRATOR:	MCDONALD, DON		FACILITY TYPE:	740
ADDRESS:	3747 ATLANTIC AVENUE		TELEPHONE:	(562) 426-6123
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90807
CAPACITY:	65	CENSUS: 48	DATE:	12/07/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	ADMINISTRATOR DON MCDONALD		TIME COMPLETED:	11:30 AM

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 12/07/2022 around 09:30 AM Licensing Program Analysts (LPA) Jose Calderon conducted an announced face to face visit with Administrator Don McDonald with The Laurel at Long Beach Facility for purpose of a pre-licensing evaluation. The requested capacity is for 65 ambulatory, non-ambulatory Adult Resident Facility 65-year-old and older. The Six-story commercial building consists of (57) resident bedrooms, (57) resident bathrooms, (12) common bathrooms, dining room, commercial kitchen, staff room, media rooms, office area, washer and dryer/ storage area, backyard with umbrella with table and chairs. Residents Bedrooms: All 57 Bedrooms are for ambulatory/non-ambulatory clients. Bedroom’s #412 and #413 and #416 and #514, and #515 has one bed each, one chair, one-night stand, one lamp, one dresser. Bathroom: Have a working toilet, wash basins, and walk-in shower, grab bars. LPA Calderon observed adequate lighting in hallway leading to bathrooms. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored in hall storage room.. Emergency Phone Numbers, Exit Plan & Menu: The telephone system is a land line and operable. Emergency Disaster Plan and "See something, say something Let Us Know" was noted. Fire Extinguisher 30 mounted on the wall in hallways on every floor and in the kitchen.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

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: LAUREL AT LONG BEACH, THE	FACILITY NUMBER: 198320315
	VISIT DATE: 12/07/2022

NARRATIVE

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Food Service: Dishes, cups and flat ware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are stored in a locked cabinet located in the kitchen area. Food supply is adequate; stored in 3 commercial kitchen refrigerator and storage area and consists of the following: A variety of Fresh and Canned fruit, vegetable and meat food items. Emergency water supply was noted by LPA Calderon. Smoke Detectors: 100 hard wired smoke detectors are battery and electric. operated & working. 100 Carbon monoxide detectors located and mounted in the hallway is operational. Appliances: Gas Stove, oven, microwave, washer, and dryer working. Commercial Refrigerator (3) in the kitchen has a measured temperature of at least 37 degrees Fahrenheit for appropriate food storage. Freezer is at 0 zero degrees Fahrenheit. The residence is equipped with central air and heat and each client bedroom is individually climate controlled. Toxins: Locked/stored in the storage room located in on each floor. Water Temperature: Bathrooms water temperature tested in #1 at 105 F. and #2 106 F. degrees, and #3 102 F degrees, and #4 107 F degrees, Kitchen water temperature tested at 115 F degrees. Medications, First-Aid Kit & Book: Medication administration records storage area, and first aid kit has been inspected, which are stored in locked kitchen cabinet adjacent the refrigerator, available for staff use but inaccessible to clients.

Clients & Staff Files: Applicant will NOT be handling cash resources of clients and NO surety bond will be needed. Records of staff and clients shall be stored in a locked in staff closet and the section has been inspected.

Reading Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the client's use. LPA Calderon did not observe any pet or bodies of water at the facility. LPA Calderon did not observe delayed egress, chain locks or dead bolts on exits. LPA Calderon did not observe pad locks or other mechanisms which may be obstructions for safe and quick egress during an emergency on side gates and front exits. Pool/Jacuzzi & Pets: LPA Calderon did not observe any pet or bodies of water at the facility. Fire clearance: Fire Clearance was approved on 09/23/2022 for 65 non-ambulatory, ambulatory clients with no special instructions by Long Beach Fire Department. LPA Calderon did not observe delayed egress, chain locks or dead bolts on exits. LPA Calderon did not observe pad locks or other mechanisms which may be obstructions for safe and quick egress during an emergency on side gates and front exits.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

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: LAUREL AT LONG BEACH, THE	FACILITY NUMBER: 198320315
	VISIT DATE: 12/07/2022

NARRATIVE

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Component III: (07/15/2022) about how to operate the facility within substantial compliance was reviewed with Administrator Don McDonald.

An exit interview was conducted with Administrator Don McDonald, and a copy of this report has been furnished to the applicant by hand. Accordingly, LPA Jose Calderon will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2022

LIC809 (FAS) - (06/04)

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