198601838-8-30-2021-28-AS-KLOG-C6DTKB-20210830144740

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198601838
Report Date: 08/30/2021
Date Signed: 08/30/2021 02:48:32 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	DOWNEY RETIREMENT CENTER		FACILITY NUMBER:	198601838
ADMINISTRATOR:	MICHELE R GOODNEY		FACILITY TYPE:	740
ADDRESS:	11500 DOLAN AVENUE		TELEPHONE:	(562) 869-2416
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90241
CAPACITY:	252	CENSUS: 94	DATE:	08/30/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Michele Goodney (Administrator)		TIME COMPLETED:	03:00 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 Kruz Long conducted an unannounced visit to the facility for the purpose of an Annual Inspection. Upon arrival, LPA met with Administrator Michele Goodney and explained the purpose of the visit. The facility is a two story building which consist of: First floor: Lobby, 4 dining areas, 148 resident bedrooms (each with attached bathroom), family room, reception area, administrator office, 4 common restrooms, 2 medication rooms, kitchen, storage rooms, employee lounge, game room and a conference room. Second floor: 176 resident bedrooms (each with attached bathroom), beauty shop, records room, storage room, break room and foyers. The facility is licensed to serve age range 60 and over. 252 non-ambulatory, of which 5 may be bedridden. Bedridden rooms #136, #102, #103, #104 and #112. Hospice waiver for 30. During today's inspection, LPA observed the following: Facilities maintains in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. Facility is not operating over capacity or beyond any conditions and limitation on the license. No pools and bodies of water on the premises. No ammunition or firearms on the premises. Facility maintains a comfortable temperature for residents. All outdoor and indoor passageways are free of obstruction. Hot water temperature measured between 105 degrees F and 120 degrees F. The presence of grab bars for each toilet, bathtub and shower used by residents was observed. Bathtub or shower have non-skid mats or strips. Beds have the required linen/supplies which include pillowcase, mattress pads, fitted sheet, blanket and bed spreads. Adequate supply of linens are stored in supply room. Facilities have a signal system that operates from each resident’s living unit. Minimum of one week supply of nonperishable foods and 2 days of perishable foods was observed. All readily perishable foods or beverages capable of growth of micro-organisms is stored in covered containers at appropriate temperature. Smoke and Carbon Monoxide detectors are operable. The facility has sufficient and competent staff to provide the services needed to meet resident needs. Continue to LIC809C...

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz Long	TELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: DOWNEY RETIREMENT CENTER	FACILITY NUMBER: 198601838
	VISIT DATE: 08/30/2021

NARRATIVE

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Delayed egress devices is not substituted for trained staff in sufficient numbers to meet the needs of all dementia residents and to escort residents who leave the facility. Items that could constitute a danger is stored inaccessible to dementia residents. A first aid kit has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze, first aid manual available for staff use but inaccessible for residents. Staff assisting residents with ADLs have required training. Criminal Record Clearance for required persons is associated to the license. Staff responsible for direct care and supervision have current first aid training. Facility have a disaster and mass casualty plan. Employees of CCLD is allowed to enter the facility to conduct inspections. A certified administrator is on the premise for a sufficient number of hours to manage and oversee the business operation. Medications is given per the physician’s directions. Centrally stored medicines is kept in a safe and locked place.

No deficiencies were observed during today's visit.

An exit interview was conducted and a copy of this report was provided to Michele Goodney.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz Long	TELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

LIC809 (FAS) - (06/04)

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