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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320364
Report Date: 09/25/2024
Date Signed: 09/26/2024 09:05:39 AM


Document Has Been Signed on 09/26/2024 09:05 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:THRIVE BOUTIQUE SENIOR LIVING - REDONDO BEACHFACILITY NUMBER:
198320364
ADMINISTRATOR:NEMETH, JOHNFACILITY TYPE:
740
ADDRESS:2011 GRAHAM AVENUETELEPHONE:
(310) 493-1221
CITY:REDONDO BEACHSTATE: CAZIP CODE:
90278
CAPACITY:6CENSUS: 6DATE:
09/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Raul CubillasTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced required 1-year annual visit with the primary focus on Infection Control measures and using the new CARE Inspection Tool. Upon arrival at the facility, LPA Bunker conducted a risk assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA was properly screened for COVID-19 symptoms and temperature was checked. LPA Bunker met staff member Raul Cubillas and explained the purpose of today's Annual Inspection. LPA verified that the facility has an approved mitigation plan and infection control plan. There are currently six (6), Residential Care Facility for the Elderly (RCFE) residents in placement. The facility has a hospice waiver and is qualified to provide care for Dementia residents aged 60 and older. The facility's annual fees are current.

The facility is a two-story family home located in a residential neighborhood. The facility consists of, six resident bedrooms, five bathrooms, a living room, a dining area, an office/laundry space, and an elevator. The spacious resident bedrooms are designed to accommodate the residents' personal furnishings. The dining room includes a fireplace with a secured metal protective screen cover, ensuring it remains inaccessible to residents. There is a patio/courtyard, shaded areas, an indoor/outdoor activity area on the left side of the house, and a balcony on the second floor.

Due to time constraints, LPA Bunker will come back at a later date to complete the visit.

There were no deficiencies cited.

An exit interview was conducted.
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela BunkerTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2024
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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