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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602039
Report Date: 09/02/2023
Date Signed: 09/05/2023 08:04:13 AM


Document Has Been Signed on 09/05/2023 08:04 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:REGENT VILLA RETIREMENT HOMEFACILITY NUMBER:
198602039
ADMINISTRATOR:GORDON, JENNIFACILITY TYPE:
740
ADDRESS:201 W WARDLOW RDTELEPHONE:
(562) 595-6529
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY:188CENSUS: 130DATE:
09/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:56 AM
MET WITH:DIRECTOR KATHY ZEPDATIME COMPLETED:
03:30 PM
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On 09/02/2023 at 09:00 AM, Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced annual inspection visit at Facility Regent Villa Retirement Home. LPA Calderon was allowed entry into the facility by Director Kathy Zepeda. The facility is licensed for 188 residents aged 59 and over. Currently, there are 130 residents residing in the facility.

LPA Calderon explained to Director Kathy Zepeda, the purpose of the 1-year Annual Inspection visit, and Director Zepeda escorted LPA Calderon on a tour of the entire inside and outside facility grounds. As part of the inspection, LPA Calderon reviewed: Ten (10) resident service records, Ten (10) resident medication records. LPA Calderon interviewed ten (10) residents and six (6) staff members for visit. LPA Calderon inspected the inside facility and outside grounds. The facilities’ last fire drill was conducted on 08/30/2023. The two story commercial building consisting of (94) resident bedrooms, (94) resident bathrooms, eight (8) common bathrooms, dining room, commercial kitchen, staff area, office area, commercial washer and dryer room/ storage area, Movie room, activity room, backyard with umbrella with table and chairs. No weapons are stored in the premises. Commercial Kitchen was inspected and observed to be clean and operational. A 2-day supply perishable and 7-day supply of non-perishable foods are present in the facility kitchen. Seven (7) day emergency water supply located in the kitchen and storage room areas.

LPA Calderon observed that all facility rooms are clean and in good repair. A comfortable temperature was observed, and the facility has central air and heating. LPA Calderon observed the following during inspection of resident’s #11, #13, #15, #23, #27, and #29 rooms. LPA Calderon noted that resident mattresses are in good condition, there is adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. All bedrooms contain furniture, lighting fixtures and personal storage space as required, all beds have the required amount of linen and mattress covers, LPA Calderon observed fully stocked storage room with bedding, towels, and toiletries supplies. Bathroom fixtures are clean, in good repair, and working properly and contain the required nonskid mats and grab bars.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:
DATE: 09/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/02/2023
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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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: REGENT VILLA RETIREMENT HOME
FACILITY NUMBER: 198602039
VISIT DATE: 09/02/2023
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LPA Calderon observed bathrooms were found to be within Title 22 regulation. Bathroom #1 hot water temperature properly measured at 108 degrees Fahrenheit, and bathroom #2 hot water temperature properly measured at 106 degrees Fahrenheit. Bathroom #3 hot water temperature properly measured at 108 degrees Fahrenheit. Bathroom #4 hot water temperature properly measured at 107 degrees Fahrenheit. Commercial Kitchen hot water temperature properly measured at 118 degrees Fahrenheit. Facility ten (10) Carbon Monoxide and (107) Smoke Detectors are hard wired and connected to each other. Smoke detectors were tested and are working properly. The facility has twenty (20) Fire Extinguishers that were checked and found to be fully charged and accessible to staff and residents. All exit doors in the facility have alarm systems and security pads to unlock doors. All toxins and knifes are locked/secured and inaccessible to residents. Residents’ medications are centrally stored in the locked medication room and in a locked storage cabinet while on facility grounds. Facility has ten (10) first aid kits which are fully stocked with manuals was checked and in order. Outside grounds were toured and water fountain was observed in the patio area. All Exits/ Walkways around the facility were free of debris and hazards. Outside patio accessible to residents. Ten (10) resident medications reports were checked, and they were all found to be administered according to doctor's orders. Six (6) staff files were checked and have the required documents. The facility does handle resident's money/cash resources. A surety bond #03328032 for a total coverage of $50,000 dollars underwritten by International Fidelity Insurance Company is valid at time of inspection. LPA Calderon noted the Administrator Jenni N Gordon Certification # 6043222740 expiration date of 10/21/2023 was valid at time of visit. Commercial General Liability Policy #GLP130347706 policy period from 01/27/2023 to 01/27/2024 underwritten by Great American Insurance Company, coverage 2,000,000/5,000,000 is valid at time of inspection. LPA Calderon spoke to Director Kathy Zepeda who will email full copy of insurance contract which shows all coverages to LPA Calderon no later than 09/14/2023. All the required documents are posted in the facility in a clearly visible area to all staff, residents, and guests. LPA Calderon reviewed LIC500 and noted all staff associated to facility per LIS. LPA Calderon reviewed the resident roster, LPA Calderon confirmed residents’ interview are on resident roster.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2023
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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: REGENT VILLA RETIREMENT HOME
FACILITY NUMBER: 198602039
VISIT DATE: 09/02/2023
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During the visit, LPA Calderon observed the facility infection control practices. LPA Calderon observed screening protocols for visitors, staff, and residents, sanitizing stations (Located in common areas and restrooms). LPA Calderon observed staff and residents were not wearing face coverings throughout the facility. LPA Calderon observed the facility has a 30-day supply of Personal Protective Equipment (PPE).

LPA Calderon advised the Director Kathy Zepeda to continuously monitor the Centers for Disease Control (CDC) website and Community Care Likening Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance.
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According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA Calderon did not observe any deficiencies therefore no citations were issued at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Director Kathy Zepeda.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2023
LIC809 (FAS) - (06/04)
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