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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320478
Report Date: 06/07/2024
Date Signed: 06/07/2024 04:56:43 PM


Document Has Been Signed on 06/07/2024 04:56 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:AVOCET AT PLAYA VISTAFACILITY NUMBER:
198320478
ADMINISTRATOR:MCGEVNA, KEITH MFACILITY TYPE:
741
ADDRESS:12490 FIELDING CIRCLETELEPHONE:
(424) 216-7788
CITY:PLAYA VISTASTATE: CAZIP CODE:
90094
CAPACITY:286CENSUS: 213DATE:
06/07/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Keith McGevnaTIME COMPLETED:
05:15 PM
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On 06/07/2024, Licensing Program Analysts (LPAs), Ernand Dabuet and Regina Cloyd, conducted an announced visit to the facility for purpose of a prelicensing evaluation. . LPAs met with Executive Director Keith McGevna and the purpose of today's visit was explained. An application was submitted to CCLD on 04/02/2024 for Change of Ownership for a Residential Care Facility for the Elderly to serve the Elderly for 60 years and older. The requested capacity is for 286 in which 188 may be ambulatory only, 70 non-ambulatory and 28 bedridden.

During today’s visit, LPAs and Executive Director toured the facility. The physical plant included floors 1-6, basement, both inside and outside. The facility has an enclosed pool on the 6th floor with a staff member stationed there during business hours. There is a salon, a gym, a card room and arts and craft for residents enjoyment. LPAs toured apartments which house residents with independent living capabilities and memory care (first floor). They include 1 or 2 bedrooms, 1-2 bathrooms, living room, kitchen, and laundry room. Residents have the option to furnish apartments with their own furniture. There is furnishings available if requested. Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. The bedrooms are set up with beds, night stands with lamps, dressers, and closet space. LPA tested the hot water temperature on each floor to ensure it is maintained within the required range of 105*F - 120*F degrees.

LPA observed the call signal system in the bathrooms, showers, and hallways. Facility is equipped with smoke detectors and strobe detectors were observed in the common areas w/speakers in the rooms & hallways, including a carbon monoxide device on every floor. Fire clearance was approved on 04/19/24.

Continue to LIC 809-C.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina CloydTELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2024
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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