198601778-7-19-2023-28-AS-CWOG-CTUVRN-20230718164012

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198601778
Report Date: 07/18/2023
Date Signed: 07/19/2023 08:42:44 AM

Document Has Been Signed on 07/19/2023 08:42 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	BROOKDALE UPTOWN WHITTIER		FACILITY NUMBER:	198601778
ADMINISTRATOR:	PRECIOSA (SUZIE) MAGPAYO		FACILITY TYPE:	740
ADDRESS:	13250 E PHILADELPHIA ST		TELEPHONE:	(562) 945-3904
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90601
CAPACITY:	280	CENSUS: 107	DATE:	07/18/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	PRECIOSA (SUZIE) MAGPAYO		TIME COMPLETED:	04:45 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	Licensing Program Analyst (LPA) Wong conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to Administrator PRECIOSA (SUZIE) MAGPAYO and assisted LPA with the visit. There are currently 107 elderly residents 60 years and older residing in the facility. Eight (8) residents are receiving hospice care. The following 12 (CARE) tool domains were utilized during the inspection: Infection Control, Operational Requirements, Physical Plant/Environment Safety, Staffing, Personnel Records/Staff Training, Resident Records/Incident Reports, Planned Activities, Food Service, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. 1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. COVID-19 screening is no longer in place. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. 2.Operational Requirements: A current Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan. The facility does not have a Dementia Waiver in place. A hospice waiver is approved for 8 residents. A fire clearance for 280 non-ambulatory residents. Liability Insurance in the amount of $5,000,000 per occurrence and $5,000,000 in total annual aggregate is in place. No Surety bond is in place. Facility does not handle resident monies. 3. Physical Plant/Environmental Safety: The facility is a four story building. The facility does not have a dementia unit. A hospice waiver for 8 residents are in place. On the first floor, it includes: 26 residents rooms, TV lounge, reception area, executive director office, dining room, kitchen, coffee station, med-room, activity room, conference room, library, commercial laundry room and courtyard. On second floor, it includes 44 residents rooms, laundry room and sun deck.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BROOKDALE UPTOWN WHITTIER	FACILITY NUMBER: 198601778
	VISIT DATE: 07/18/2023

NARRATIVE

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On third floor, it includes 44 residents rooms, laundry room, Wellness Center and residents' rest/puzzle area. On the forth floor, it includes 36 residents' rooms. laundry room and game area. LPA inspected Rm#101, #115, #216, #220, #237, #314, #333, #407, #420, #423, they all have required grab bar and non-skid mat in the bathroom. Each residents' bathrooms are clean, sanitary and in a operable condition. LPA tested all 10 residents room hot water temperature and its between 109.4 and 118.4 degrees F. which are within Title 22 regulation. LPA also inspected the smoke detectors and carbon monoxide detectors and they are all working well. Each residents room have the required furniture, bedding and sufficient lighting and closet space. The facility have a telephone services in the premises and each resident phone # are listed on the facility directory.

4. Staffing: The facility has sufficient staffing in the facility to provide care and supervision to residents. All staff are over 18 years old. The NOC shift staff does have updated first aid certificate and required emergency procedure training. Also LPA inspected the facility signal system and they are all working well. The facility also has at least one person on call in the premises.

5. Personnel Record/Training's : The Administrator is Susie Magpayo and her administrator certificate will be expired on 8/10/2023. All the facility staff have criminal background clearance and associated with the facility and the required training. Seven (7) staff files were reviewed. Proof of staff training, health clearance, food handling certificates, and all staff has an updated First Aid /CPR certificate.

6. Residents Records-Incident Reports: A total of ten (10) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisal, TB clearance, Functional Capability Assessment, Physician's Orders, medical consent, and medication records.

7. Residents Right-Information: RCFE complaint poster and Personal rights were observed and its posted near the entrance and reception area.

8. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed.
An activity calendar is posted on the wall near the dining room and each resident would receive the activity calendar beginning of the month and also different activities poster also posted in the elevator . The facility also has a Resident Council.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BROOKDALE UPTOWN WHITTIER	FACILITY NUMBER: 198601778
	VISIT DATE: 07/18/2023

NARRATIVE

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9. Food Services: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Physician orders for modified diets are on residents' file. LPA observed all the food are stored probably.

10. Incidental Medical and Dental Services: Ten (10) centrally stored resident medications were reviewed; containing 30-day supply of medications. Medical and dental transportation is provided.

11. Disaster Preparedness: The facility has an updated Emergency and Disaster Plan was reviewed and dated on 01/20/23 and the evacuation chair at each stairway is in place. The last fire and disaster drill was conducted on 06/15/2023. The facility also has two alternative temporary shelter locations.

12. Resident with Special Health Needs: 4-5 residents are receiving home health services. Eight (8) resident receive hospice care. No postural support residents currently reside in the facility. No half bed or full bed rails were observed in resident rooms. Individual Service Plans and Appraisals are on File. No residents have prohibited health condition.

No deficiencies were observed during the annual inspection

Exit Interview conducted and a copy of the report was provided to Administrator PRECIOSA (SUZIE) MAGPAYO

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

LIC809 (FAS) - (06/04)

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