<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601838
Report Date: 08/31/2022
Date Signed: 08/31/2022 02:16:18 PM


Document Has Been Signed on 08/31/2022 02:16 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:DOWNEY RETIREMENT CENTERFACILITY NUMBER:
198601838
ADMINISTRATOR:MICHELE R GOODNEYFACILITY TYPE:
740
ADDRESS:11500 DOLAN AVENUETELEPHONE:
(562) 869-2416
CITY:DOWNEYSTATE: CAZIP CODE:
90241
CAPACITY:252CENSUS: 105DATE:
08/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Michele Goodney (Administrator)TIME COMPLETED:
02:30 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 an annual inspection. 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 with an attached bathroom, family room, reception area, administrator office, 4 common restrooms, 2 medication rooms, kitchen, storage rooms, employee lounge, game room, conference room and outdoor seating area. Second floor: 176 resident bedrooms with an 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: Physical Plant and Environmental Safety: Sufficient lighting, non-skid matts in all bathrooms inspections, comfortable temperature, hot water temperature measured between 105 degree F to 120 degree F in the bathrooms, bathing facilities in operable condition, operable signal system, no bodies of water on the premises, no firearms on the premises, toxins stored inaccessible to residents. Operational Requirements: Facility has an approved fire clearance for non-ambulatory persons and plan for dementia care. Staffing: There is sufficient staff, the administrator is on the premises during normal business hours. Personnel Records - Training: Staff has criminal record clearance, staff have sufficient hours of training and current first aid/CPR training. Resident Records/Incident Reports: Admission agreement, medical assessment and appraisal observed. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities, furnished areas is provided for relaxation of residents and entertaining friends and relatives. Food Services: Perishable foods are stored in covered containers, toxins are stored separate from foods, kitchen is kept clean. Incidental Medical and Dental: Licensee provide assistance in meeting medical and dental needs for residents, all centrally stored medications is labeled and maintained in compliance with state and federal law.

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 FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz LongTELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1