198320498-7-18-2024-11-AS-SLEO-D7AUU8-20240718155308

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320498
Report Date: 07/18/2024
Date Signed: 07/18/2024 03:53:22 PM

Document Has Been Signed on 07/18/2024 03:53 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 LVNG. FACILITY		FACILITY NUMBER:	198320498
ADMINISTRATOR:	CAMARIN JOHNSON		FACILITY TYPE:	740
ADDRESS:	3540 MARTIN LUTHER KING, JR.		TELEPHONE:	(310) 638-4113
CITY:	LYNWOOD	STATE: CA	ZIP CODE:	90262
CAPACITY:	178	CENSUS: 59	DATE:	07/18/2024
TYPE OF VISIT:	Post Licensing	UNANNOUNCED	TIME BEGAN:	10:50 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 07/18/2024 at around 10:50 AM, Licensing Program Analyst (LPA), Leandro conducted an unannounced Required Post-Licensing Inspection to the above-named facility and met with Administrator, Camarin Johnson. LPA explained the purpose of the visit and was accompanied by a staff member inside and outside the facility during this inspection. This facility is licensed to serve adults ages 55 and above. This facility has a capacity for 108 ambulatory residents and 70 non-ambulatory residents making it a total capacity of 178 residents. A total of 59 residents are currently residing in this facility. 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.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024

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 4

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 LVNG. FACILITY	FACILITY NUMBER: 198320498
	VISIT DATE: 07/18/2024

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

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

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.

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. Documents are posted as mandated. There are several fire extinguishers around the facility.

5 staff records were reviewed, 5 out of 5 staff records had required documentation.

5 resident records were reviewed and, 5 out of 5 resident records had required documentation.
LPA reviewed Client 1’s (C1) blood sugar summary for the month of July 2024. C1 had missing blood sugar checks on 7/1, 7/2, 7/5, 7/15, and 7/16. LPA interviewed C1, and C1 explained that she checks her blood sugar every day with the assistance of staff. Once C1 checks her blood sugar she then proceeds to inject herself with insulin.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4

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 LVNG. FACILITY	FACILITY NUMBER: 198320498
	VISIT DATE: 07/18/2024

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

LPA followed up on items numbered 1 through 9 below.

1. bedrooms 142, 145, 144, 149, 154, and 158 are missing beds. – LPA observed beds in these bedrooms.

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. – LPA observed enough linen for facility 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. – LPA observed blinds and screen doors in good repair.

4. Closet door are not in good repair throughout bedrooms 23, 25, 26, 27, 33, 37, and 12. – LPA observed closet doors in good repair.

5. Bathroom sink and shower faucet drips in bedroom 31. – LPA observed sink and shower faucet in good repair.

6. There are cracks and/or holes in bedroom bathrooms 2, 10, 25, 27, 31, and 34. – LPA observed bathroom walls in good repair.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

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 LVNG. FACILITY	FACILITY NUMBER: 198320498
	VISIT DATE: 07/18/2024

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

7. LPM observed water stains throughout the second-floor ceiling and must be repaired and re-painted. – LPA observed fresh paint on the ceiling of the second floor.

8. North stairwell is missing an evacuation chair. – LPA observed an evacuation chair.

9. First floor memory care unit egress door is in disrepair because it does not open after 15 seconds. – LPA observed first-floor south egress door in good repair. LPA observed north egress door not opening after 15 seconds. LPA observed documentation confirming that technicians came on 5/28/2024 to fix egress doors. On 06/07/2024, LPA observed video conforming that the north egress door was in good repair. Technicians will be coming tomorrow, 07/19/2024, to fix the north egress door.

No deficiencies were cited. There is one technical violation which is the first-floor north egress door not opening after 15 seconds. And a technical advisory which is the documentation of blood sugar checks for people with diabetes.

An exit interview was conducted, and a copy of this report was left with the Administrator.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024

LIC809 (FAS) - (06/04)

Page: 4 of 4