198600562-1-6-2023-11-AS-WGIS-CMC4XS-20221221183002

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198600562
Report Date: 12/16/2022
Date Signed: 01/06/2023 04:37:16 PM

Document Has Been Signed on 01/06/2023 04:37 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	BIANCA RESIDENTIAL CARE		FACILITY NUMBER:	198600562
ADMINISTRATOR:	HARRISON, JANICE		FACILITY TYPE:	735
ADDRESS:	4600 WEST 166TH STREET		TELEPHONE:	(310) 370-2924
CITY:	LAWNDALE	STATE: CA	ZIP CODE:	90260
CAPACITY: 4		CENSUS: 3	DATE:	12/16/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:08 PM
MET WITH:			TIME COMPLETED:	03:00 PM

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Licensing Program Analyst (LPA) Wendy Gibbs conducted an unannounced required annual visit with a primary focus on infection control measures using the CARE inspection tool. The facility is licensed for four (4) ambulatory clients, of which two (2) may be non-ambulatory. Currently, there are three (3) ambulatory clients. LPA met with Sarita Wellington and toured the inside and outside grounds of the facility.

Structure The facility is in a residential neighborhood. It has four (4) resident room, one (1) staff room, two (2) individual restrooms, one (1) full bathroom, kitchen, living room, and attached garage.

Physical Plant LPA walked the grounds. The front is surrounded by an unlocked fence. There are a table, chairs, and umbrella available for resident use on the patio in the front yard. LPA walked all walkways in the back and observed they were free of obstructions, debris, and hazards. There were no bodies of water observed.

Bedrooms LPA walked through all resident bedrooms. All rooms had the required furniture, including bed, chair, dresser, and nightstand. Each room had ample lighting and closet space. All beds had a mattress cover, fitted sheets, blankets, comforter and pillow.

Bathrooms LPA checked all resident bathrooms. Two of the resident’s rooms have private restrooms, in both the toilet and faucets are in good working order and they have ample lighting. There is one full resident bathroom, the toilet and faucet is in good working orderr. The shower was free of mold and mildew and has a nonskid mat and secured handrails. The water temperature measured between 112.8 and 118.3 degrees Fahrenheit.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022

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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: BIANCA RESIDENTIAL CARE	FACILITY NUMBER: 198600562
	VISIT DATE: 12/16/2022

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Linens LPA observed an ample supply of linens, towels, and hygiene products in the hall cupboard. In the resident’s closets there were additional blankets and comforters.

Kitchen All appliances were in good working condition. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods. Garage had additional food stored. All cutleries were in good condition. Knives and toxins were locked in a cabinet and inaccessible to residents. The water temperature measured 116.7.

Common Areas All common areas were clean and clear of hazards; doorways were free of obstructions. LPA observed activities and games available for residents.
Files LPA reviewed all resident files, which included all required documentation. LPA also reviewed all staff files, which included all required documentation and verification of training. LPA reviewed Surety Bond which expires in 05/2025
Medications All medications were centrally stored in their original packaging and were securely locked away, and inaccessible to residents. LPA reviewed all resident medications and MARs.
Infection Control Upon entry LPA was properly screened for Covid-19 symptoms and temperature was checked. During the tour, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance; visitors log with Covid-19 screening and temperature log was present. PPE supplies are readily available to staff, and an additional 60-day supply of PPE is stored in the garage; sufficient paper, cleaning, and disinfecting supplies were observed. The facility’s designated visitation area is the front of the house and living room. LPA observed staff, and clients wearing a face covering. LPA observed required postings throughout the facility.
Safety All resident rooms had a smoke detector and the hallway and dining room. They were found to be in good working condition. Carbon monoxide detector was in good working condition. One fire extinguisher was observed, fully charged, in the kitchen area. LPA inspected the First Aid Kit and found that it had all the required item and the manual. The last fire drill was on 12/05/2022. All exits were marked and all required posting were posted.

No deficiencies were cited during this visit.

No technical assistance / violations were cited during this visit

An exit interview was conducted, and a copy of this report was provided.

(LPA came back on additional date due to lack of time).

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022

LIC809 (FAS) - (06/04)

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