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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601817
Report Date: 06/02/2023
Date Signed: 06/04/2023 08:25:49 PM


Document Has Been Signed on 06/04/2023 08:25 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:ST JOHN GRANDEFACILITY NUMBER:
198601817
ADMINISTRATOR:SABRINA TUCKERFACILITY TYPE:
740
ADDRESS:2446 S ST ANDREWS PLACETELEPHONE:
(323) 731-0641
CITY:LOS ANGELESSTATE: CAZIP CODE:
90018
CAPACITY:51CENSUS: 45DATE:
06/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:06 AM
MET WITH:Administrator Edguardo GalangTIME COMPLETED:
01:15 PM
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On 06/02/23, Licensing Program Analyst (LPA) Lizeth Villegas conducted an unannounced annual visit and met with the Administrator Edguardo Galang while the purpose of today’s visit was explained. The facility is licensed to serve 38 non-ambulatory and 13 bedridden residents ages 60 and above and have a hospice waiver approved for 8.

The facility has 3 floors and is located in a residential area, the physical plant consists of the following: Receptionist Area, medication office, Cinema, Game room, Kitchen, dinning room, laundry area, staff offices and a large shaded patio/garden area. LPA and Administrator toured the facility, all resident rooms were checked. Mattresses and box springs were in good condition, plenty of dresser and closet space was observed. Walls and floors were clean and in good repair. Bed linens, comforters and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulation. Toilet and water faucets worked properly, water temperatures measured between 105F. to 120 F. and showers were free of mold/mildew. LPA reviewed 2 staff files, 4 resident files and 4 resident medication administration records. LPA interviewed 4 residents and 2 staff.



While touring the dining room/kitchen area; LPA observed these areas to be clean and well maintained. LPA observed ample food supply,storage areas for cleaning solutions, toxins, knives, and hazardous items were secured and made inaccessible to Residents. Last fire drill conducted with LAFD was on March 3rd, 2023, fire extinguishes were observed to be charged, smoke detectors and carbon monoxide detectors observed to be operational. First aid kit was checked and fully stocked. A landline was observed located in resident rooms. Outside grounds were toured and no bodies of water were observed. Exits/ Walkways around the facility were free of debris and hazards. During today’s visit LPA did not observe any deficiencies.

Exit interview conducted with Administrator Edguardo Galang, and a copy of this report was provided.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Lizeth VillegasTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2023
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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