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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320498
Report Date: 08/08/2024
Date Signed: 08/08/2024 04:22:39 PM


Document Has Been Signed on 08/08/2024 04:22 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245



FACILITY NAME:GENERATIONS OF LOS ANGELES ASSISTED LVNG. FACILITYFACILITY NUMBER:
198320498
ADMINISTRATOR:CAMARIN JOHNSONFACILITY TYPE:
740
ADDRESS:3540 MARTIN LUTHER KING, JR.TELEPHONE:
(310) 638-4113
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:178CENSUS: 55DATE:
08/08/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:36 PM
MET WITH:Cammy Johnson (AdministratorTIME COMPLETED:
04:30 PM
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On 08/08/2024 at 1:30 pm Licensing Program Analyst Hollie Enriquez (LPA) and Licensing Program Manager Ulysses Coronel (LPM) conducted an unannouced Case Management-Other visit and met with Administrator, Camarin Johnson. LPM explained the purpose of the visit and the Administrator accompanied LPA and LPM on the physical tour of the facility interior.

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. There are 58 residents in care at facility at the time of the visit.

At 1:45 pm, Administrator accompanied LPA and LPM on a tour of the facility interior. The second floor delayed egress door to the Memory Care unit was tested and did not delay exit, opened immediately and did not have any alarm sound to signal staff. Memory Care unit on the second floor is fully vacant and has no residents in care. LPA and LPM observed on the second floor by room 186 an area of open dry wall exposing a pipe. Linen closet was fully stocked and second floor stairwell chairs observed. First floor kitchen was toured. Kitchen was sanitary and stocked.

LPA and LPM reviewed five (5) resident files. LPM and LPA observed that one (1) out of five (5) Admissions Agreements, pages 3-4 under section Monthly Rental did not indicate an actual monetary amount under the monthly SSI/SSP rate. Only "SSI" was indicated.

No citations were issued at this visit. A copy of the report and Advisory Notes - Technical violations have been provided to the Administrator.


SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Hollie EnriquezTELEPHONE: (916) 908-8866
LICENSING EVALUATOR SIGNATURE:
DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2024
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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