198320315-9-11-2024-11-AS-DLEE-D8ZU9Y-20240911152355

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320315
Report Date: 09/11/2024
Date Signed: 09/11/2024 03:24:18 PM

Document Has Been Signed on 09/11/2024 03:24 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:	BAY TOWERS AT BIXBY KNOLLS		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: 36	DATE:	09/11/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:28 AM
MET WITH:	Don McDonald		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 September 11, 2024, at 9:00 AM, Licensing Program Analyst (LPA), Deborah Lee arrived at facility above to conducted an unannounced Required – 1 Year Inspection to Bay Towers at Bixby Knolls facility and met with the Residents Services Director, MaryLou Escobedo and Executive Director Don McDonald. LPA explained the purpose of the visit and was accompanied by the Resident Services Director to tour the facility inside and out. This facility is licensed to serve 65 non-ambulatory, ambulatory adults ages 60 and above. There is an approved Hospice Waver for 10. Facility Structure The facility is a 6-story commercial building located on a main street. There are two buildings on the property separated by a parking lot. The Independent Living building is not licensed by Community Care Licensing (CCL). The Assisted living building is licensed by (CCL) The Assisted Living building consist of 57 resident bedrooms, 57 resident bathrooms, and occupies the 4th, 5th and 6th floors. Living area/Common rooms: LPA inspected living spaces and common areas. LPA observed the furniture to be in good repair and adequate seating for the residents in care. There is adequate space for indoor activities. Page 1 of 3

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Deborah Lee	TELEPHONE: (424) 544-1051
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

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: BAY TOWERS AT BIXBY KNOLLS	FACILITY NUMBER: 198320315
	VISIT DATE: 09/11/2024

NARRATIVE

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Resident Bedroom/bathrooms:
Several residents’ bedrooms/bathrooms were checked. Mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Bathroom toilets and water faucets worked properly, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries accessible to residents. This facility provides toilet paper to all residents.
Kitchen/Dinning area:
LPA toured the kitchen area and observed supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Knives and toxins were kept in locked storage cabinet.
Safety:
LPA observed that medications were safe, locked, and inaccessible. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. All required documents are posted. Last Disaster drill was conducted on 08/26/2024. First aid kit is fully stocked with manual. Smoke and carbon monoxide detectors were in compliance and operational. There was an inspection performed on 10/16/23 on the signal systems, fire alarms, fire sprinklers, elevators, etc. LPA tested hot water temperature and it measured between 105 and 120 degrees Fahrenheit.

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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: 09/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: BAY TOWERS AT BIXBY KNOLLS	FACILITY NUMBER: 198320315
	VISIT DATE: 09/11/2024

NARRATIVE

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Outside area:

Outside grounds toured and no bodies of water were observed. The patio furniture is under a shaded area and accessible to residents. Walkways around the facility were clear of hazards.

Staff/Resident Records:

5 staff records were reviewed, 5 out of 5 staff records had required Criminal Record Clearances. All staff records had require documentation. 5 resident records were reviewed and, 5 out of 5 resident records had required documentation.

LPA observed that facility maintains required liability insurance. The expiration date is 10/1/2024.

No deficiencies are being cited at this time in accordance with the California Code of Regulations, Title 22.

An exit interview was conducted and a copy of this report was left with the Residents Services Director.

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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: 09/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2024

LIC809 (FAS) - (06/04)

Page: 3 of 3