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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320496
Report Date: 09/25/2024
Date Signed: 09/25/2024 12:26:18 PM


Document Has Been Signed on 09/25/2024 12:26 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:SOFT HEART ASSISTED LIVINGFACILITY NUMBER:
198320496
ADMINISTRATOR:SUN, KEFACILITY TYPE:
740
ADDRESS:3342 ARTESIA BLVDTELEPHONE:
(310) 977-8599
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY:6CENSUS: 5DATE:
09/25/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:13 AM
MET WITH:Ke SunTIME COMPLETED:
12:35 PM
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On 09/25/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an announced pre-licensing visit to the facility listed above. LPA met with Licensee, Ke Sun, and the purpose of today’s visit was explained. There are five (5) residents residing in the facility.
An application was submitted to CCLD on 05/08/24 for a change of ownership. The facility is a Residential Care Facility for the Elderly serving residents aged 60 and over of which 6 can be non-ambulatory.
Physical Plant The facility is a single-story home in a residential neighborhood. The home consists of four (4) resident bedrooms, staff room, three (3) bathrooms, living room, sitting room, office area, kitchen, laundry room, detached garage, front and back yard. LPA observed a shaded patio with table and chairs. All windows and screens were observed clean and in good repair. There is a jacuzzi on the patio that has a locked cover and is inaccessible to residents. LPA observed all walkways to be clean, clear, and free of debris, hazards, and obstructions. All fences open easily from the inside to exit. The facility does have a fireplace that is screened and inaccessible to residents.
Bedrooms LPA inspected all resident rooms and observed them to be clean and in good repair. LPA observed the rooms have the required furniture including a bed,

(1) Continued on LIC809-C

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy GibbsTELEPHONE: (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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SOFT HEART ASSISTED LIVING
FACILITY NUMBER: 198320496
VISIT DATE: 09/25/2024
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dresser, nightstand, chair, and storage space for personal belongings. LPA observed the beds have the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillows. LPA observed a supply of linens in a cabinet in the hallway. All linens and mattresses were observed in good repair. All bedrooms were observed to have ample lighting.
Kitchen LPA inspected the kitchen and observed it to be clean and sanitary. LPA observed all appliances to be operational and in good repair. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods properly labeled, dated, and packaged. The water temperature measured 120.0-degree Fahrenheit. LPA observed an ample supply of cookware, dishware, and cutleries. LPA observed knives and sharps to be secured in a locked cabinet in the kitchen and are inaccessible to residents. LPA observed cleaning supplies to be secured in a locked cabinet under the kitchen sink and are inaccessible to residents.
Common Rooms In the living room LPA observed a couch and chairs to accommodate all residents. In the sitting room LPA observed chairs available for residents. The dining room has a large rectangular table and six (6) chairs to accommodate all residents. LPA observed in the laundry room a washer and dryer in good repair and operational. All cleaning supplies and detergents were observed secured in a locked cabinet above the washer and dryer. All walkways and hallways were observed to be clean, clear, and free of obstructions and hazards. LPA observed ample lighting and night lights in all common rooms, walkways, and

(2) Continued on LIC809-C

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy GibbsTELEPHONE: (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
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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SOFT HEART ASSISTED LIVING
FACILITY NUMBER: 198320496
VISIT DATE: 09/25/2024
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hallways. The facility was maintained at a comfortable temperature. LPA observed games, activities and reading material available for residents.
Medications LPA observed all Centrally Stored Medications were secured in a locked cabinet in the dining room and are inaccessible to residents. All medications were observed in their original containers.
Safety A Fire Safety Inspection was conducted and granted by Torrance Fire Department on 07/15/24. LPA observed and reviewed the facility Disaster Plan and Emergency Plan (LIC610E) and emergency numbers posted in the facility. LPA observed all required posting posted in the workspace in the sitting area. LPA observed smoke detectors to be operational. LPA observed four (4) carbon monoxide detectors, one in the dining room, two in the living room, and one in the sitting room, to be operational. LPA observed a facility sketch posted in the workspace in the sitting room. LPA observed two (2) fully charged fire extinguishers, one mounted in the kitchen and the other in the living room, purchased on 04/09/24. The last Emergency Drill was conducted on 09/12/24. LPA observed emergency flashlights in a drawer in the office area in the dining room. LPA inspected the First Aid Kit and observed it had the required items and a current manual. The facility has a working telephone. There are no firearms or ammunition on the premises.
Files LPA observed resident files secured in a locked cabinet in the office area in the dining room and are inaccessible to residents and visitors. LPA observed staff files secured in a locked cabinet in the office area in the dining room and are
(3) Continued on LIC809-C
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy GibbsTELEPHONE: (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
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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: SOFT HEART ASSISTED LIVING
FACILITY NUMBER: 198320496
VISIT DATE: 09/25/2024
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inaccessible to residents and visitors. LPA received and reviewed a copy of the Liability Insurance that is valid till 08/21/25.
Infection Control LPA observed the facilities Infection Control practices. At the entrance of the facility is a sanitizing station. LPA observed a Visitor Log with screening and temperature log. LPA was screened when entering the facility and temperature taken. LPA observed hand sanitizer and masks available. LPA observed staff wearing face masks. LPA observed infection control signs posted throughout the facility. LPA observed a 30-day supply of Personal Protective Equipment (PPE) in the closet in the sitting room.

LPA and Licensee reviewed and discussed Component III.

During today’s visit, LPA did not observe any advisory recommendations.

An exit interview was conducted with Licensee, Ke Sun, and a copy of this report was provided.

(4)

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy GibbsTELEPHONE: (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
LIC809 (FAS) - (06/04)
Page: 2 of 4