198320498-5-24-2024-11-AS-SLEO-D5KUSP-20240524155041

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320498
Report Date: 05/24/2024
Date Signed: 05/24/2024 03:51:03 PM

Document Has Been Signed on 05/24/2024 03:51 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:	GENERATIONS OF LOS ANGELES ASSISTED LIVING FACILIT		FACILITY NUMBER:	198320498
ADMINISTRATOR:	BARRIENTOS, ELEANOR		FACILITY TYPE:	740
ADDRESS:	3540 MARTIN LUTHER KING, JR.		TELEPHONE:	(310) 638-4113
CITY:	LYNWOOD	STATE: CA	ZIP CODE:	90262
CAPACITY:	178	CENSUS: 55	DATE:	05/24/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Administrator - Camarin Johnson		TIME COMPLETED:	04:00 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 05/24/2024 Licensing Program Manager (LPM) Ulysses Coronel and Licensing Program Analyst (LPA) Socorro Leandro conducted an announced visit to the facility for purpose of a pre-licensing evaluation. On 03/20/2024 an application was submitted to CCLD, for Initial license for a Residential Care Facility for the Elderly to serve adults ages 60 and over. The requested capacity is for 108 ambulatory residents and 70 non-ambulatory residents making it a total capacity of 178 residents. The facility is a two-story building located on a main street. The facility has a memory care unit and an assisted living unit. The facility has 92 resident bedrooms, 94 bathrooms, 2 atriums, 1 lounge, 3 offices, several closets, 1 doctors office, 1 conference room, 1 activity room, 1 industrial kitchen, 2 dining rooms, 1 library, 1 business office, 1 tv room, 1 staff break room, 1 facility laundry room, 1 resident laundry room, 3 emergency stairwells, 1 stairway, 2 lobbies, and 1 elevator. LPM and LPA conducted a review of the Physical Plant, Bedrooms, Bathrooms, Supplies, Food Service, Medications, Records, Administration, Activities, Pe-Licensing Checklist and Component III Orientation.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024

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: GENERATIONS OF LOS ANGELES ASSISTED LIVING FACILIT	FACILITY NUMBER: 198320498
	VISIT DATE: 05/24/2024

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MEDICATIONS
There is a locked centralized storage area for resident medications.

PHYSICAL PLANT
Facility is clean and sanitary. Protective devices are in place to include nonslip material on rugs. Indoor and outdoor passageways, stairways, inclines, ramps, open porches, and other areas of potential hazard are free of obstructions. Pools and bodies of water have fencing of at least five (5) feet high with self-closing, self-latching gates, or locked covers that can support the weight of an adult. All window screens are clean and in good repair. Facility temperature is around 74 degrees. Stairways, inclines, ramps, open porches, and areas of potential hazard are well-lit and equipped with sturdy hand railings. For facilities of 16 or more capacity there is a private office for the administrator, a reception area, and bathroom for visitors. For facilities of 16 or more capacity and facilities having separate floors or buildings without full time staff, there are signal systems in place. Fire Alarms and Smoke alarms operate properly. Carbon monoxide detectors operate properly.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024

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: GENERATIONS OF LOS ANGELES ASSISTED LIVING FACILIT	FACILITY NUMBER: 198320498
	VISIT DATE: 05/24/2024

NARRATIVE

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BEDROOMS
Halls, stairways, unfinished attics or basements, garages, storage areas, and sheds, or similar detached buildings are not being used as resident bedrooms. Resident bedrooms are large enough to allow for easy passage and to accommodate furniture and assistive devices such as wheelchairs, walkers, or oxygen equipment. No resident bedroom is a passageway to another room, bath or toilet. There is dresser and closet space for each resident that includes at least two (2) drawers or eight (8) cubic feet of dresser space per resident. There is a chair and lamp for each resident and at least one (1) nightstand per two (2) residents.

BATHROOMS
There is at least one (1) toilet and washbasin per six (6) residents, family, and personnel. There is at least one (1) shower or bathtub per ten (10) residents, family, and personnel. Hot water temperature is between 105-120 degrees Fahrenheit. Bathroom is located near resident bedrooms.

SUPPLIES
There are resident personal hygiene supplies to include feminine napkins, soap, toothpaste, toilet paper, and comb.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024

LIC809 (FAS) - (06/04)

Page: 3 of 7

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: GENERATIONS OF LOS ANGELES ASSISTED LIVING FACILIT	FACILITY NUMBER: 198320498
	VISIT DATE: 05/24/2024

NARRATIVE

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FOOD SERVICE
Dining room is near kitchen. Refrigerator(s) and freezer(s) are clean and large enough for the storage of at least two (2) days of perishable foods. Freezer is 0 degrees Fahrenheit. Refrigerator is a maximum of 45 degrees Fahrenheit. A seven (7) day supply of non-perishable food is present. There are sufficient amounts of tableware, tables, dishes, and utensils. There are sufficient amounts of equipment for the storage, preparation, and service of food. All equipment, dishes, and utensils are clean and well maintained. All kitchen, food storage, and preparation areas are clean.

RECORDS
There is confidential storage of personnel records at the facility. There is confidential storage of resident records at the facility.

ADMINISTRATION
The emergency exiting plan and emergency phone numbers are posted. Resident Personal Rights are posted. Posting both sides of the Personal Rights form LIC 613 meets this requirement. Facility Visiting Policy is posted. Licensing Complaint Poster is posted. There is space available for resident council meetings and resident council postings.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024

LIC809 (FAS) - (06/04)

Page: 5 of 7

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: GENERATIONS OF LOS ANGELES ASSISTED LIVING FACILIT	FACILITY NUMBER: 198320498
	VISIT DATE: 05/24/2024

NARRATIVE

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ACTIVITIES
For facilities of seven (7) or more capacity, an activities calendar is posted. There is an outdoor activity space with a shaded area and furnished for outdoor use. There is at least one common room available to residents for visitors. There are activity supplies to include newspapers, magazines, and a variety of reading material.

MISCELLANEOUS
There are first-aid supplies to include sterile first-aid dressings, bandages, adhesive tapes, scissors, tweezers, thermometer, antiseptic solution, and a current first-aid manual. There is space and equipment for laundry. There is a space for clean linen storage and a separate space for soiled linen. For facilities of 16 or more capacity, there is a designated laundry space. There is an operating telephone available to residents. Emergency lighting and supplies to include flashlights with batteries. Vehicles used to transport residents are in safe operating condition.

PRE-LICENSING CHECKLIST
Completed by licensee and reviewed by LPM and LPA.

COMPONENT III
Information was provided about how to operate the facility within substantial compliance.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024

LIC809 (FAS) - (06/04)

Page: 4 of 7

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: GENERATIONS OF LOS ANGELES ASSISTED LIVING FACILIT	FACILITY NUMBER: 198320498
	VISIT DATE: 05/24/2024

NARRATIVE

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During the pre-licensing inspection certain items were observed which do not comply with applicable laws and regulations; the following items must be corrected, and proof of correction shall be submitted to the CCLD office to the attention of LPA by 06/07/2024. If additional time is required to complete noted items to correct, then the applicant will request an extension in writing prior to the due date.

Some items may require a follow up inspection for verification of correction.
1. bedrooms 142, 145, 144, 149, 154, and 158 are missing beds.
2. There is an insufficient supply of clean linens to permit weekly changing or more of residents top sheets, bottom sheets, bedspreads, blankets, pillowcases, mattress covers for 178 residents.
3. Window blinds and screen doors are not in good repair throughout the first and second floor bedrooms including bedrooms 31, 33, 37, 142, 145, 147, 156, 185, and 191.
4. Closet door are not in good repair throughout bedrooms 23, 25, 26, 27, 33, 37, and 12.
5. Bathroom sink and shower faucet drips in bedroom 31.
6. There are cracks and/or holes in bedroom bathrooms 2, 10, 25, 27, 31, and 34.
7. LPM observed water stains throughout the second-floor ceiling and must be repaired and re-painted.
8. North stairwell is missing an evacuation chair.
9. First floor memory care unit egress door is in disrepair because it does not open after 15 seconds.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024

LIC809 (FAS) - (06/04)

Page: 6 of 7

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: GENERATIONS OF LOS ANGELES ASSISTED LIVING FACILIT	FACILITY NUMBER: 198320498
	VISIT DATE: 05/24/2024

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 26 27 28 29 30 31 32	An exit interview was conducted, and a hard copy of this report has been provided to the applicant. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to the applicant.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024

LIC809 (FAS) - (06/04)

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