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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320498
Report Date: 09/06/2024
Date Signed: 09/06/2024 03:32:25 PM


Document Has Been Signed on 09/06/2024 03:32 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: 0DATE:
09/06/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:26 PM
MET WITH:Administrator-Camarin JohnsonTIME COMPLETED:
03:45 PM
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On 09/06/2024 at around 1:26 pm Licensing Program Analyst (LPA) Hollie Enriquez conducted an unannounced Case Management – Other Visit. LPA met with Administrator Camarin Johnson and explained the purpose of the visit. The 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 currently 60 residents total in care at facility at the time of the visit. There are 24 residents in Memory Care and 36 residents in the Assisted Living.

At 1:36pm Administrator toured LPA through the interior of the facility. Kitchen was clean and fully stocked with additional 3 days emergency supply available. Medication Room, Activities Room, Dining Hall were observed. Common shower on the first floor was clean and sanitary.Delayed egress doors for the first floor Memory Care unit were tested and operational.

LPA toured second floor with Administrator who reported that the second floor delayed egress door to the potential Memory Care unit does not work and has not been repaired or replaced. LPA observed that door does not function with delayed egress or sound. LPA observed wall area near room 186 has been repaired and painted.

No citations were issued at this visit. A copy of the report and an Advisory Note - Technical violation has been provided to the Administrator Johnson.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Hollie EnriquezTELEPHONE: (916) 908-8866
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2024
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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