198602099-7-22-2022-11-AS-JRAE-CGKKYC-20220722081856

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602099
Report Date: 07/21/2022
Date Signed: 07/22/2022 08:19:29 AM

Document Has Been Signed on 07/22/2022 08:19 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	CORAL OAKS CARE LIVING		FACILITY NUMBER:	198602099
ADMINISTRATOR:	ELEANOR BARRIENTOS		FACILITY TYPE:	740
ADDRESS:	4271 CARLIN AVE		TELEPHONE:	(310) 763-4881
CITY:	LYNWOOD	STATE: CA	ZIP CODE:	90262
CAPACITY:	84	CENSUS: 72	DATE:	07/21/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:38 AM
MET WITH:	Administrator Eleanor Barrientos		TIME COMPLETED:	05:00 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 Jeremiah Randle conducted an unannounced visit to the facility for purpose of annual/infection control required inspection. Facility was Covid screened and reported no Covid positive cases. Today's visit, LPA met with the Administrator Eleanor (Ellen) Barrientos and explained the reasons of the visit and she also assisted with the visit. The facility is licensed for 84 non-ambulatory residents age 60 and above. Currently the facility has 72 residents 43 ambulatory and 29 non ambulatory, there's no resident with restricted health conditions. No residents are on hospice or bedridden. Fire systems inspection is scheduled with Fire Safety Service for 08/30/2022. Structure: The facility is a single story building with 42 resident bedrooms, two (2) shower rooms, reception/lobby area, dining room, kitchen, TV room, multipurpose room, business office, beauty salon room, emergency food supply room, 9 storage rooms, janitor closet, medication station, caregiver station, employee lounge, therapy room and four (4) outside patio with table and sufficient chairs. There's no body of water around the building. All outdoor and indoor passageways are free of obstruction. Bedrooms Residents: Each bedroom is for two residents. Each room has two beds, two nightstands, two closets, two chairs and adequate lighting. Each room has dementia alarm system and they are all working properly. There are four private rooms that are occupied by residents. Bathrooms: All bathrooms have a working toilet, wash basin and shower. During the visit, LPA observed nonskid mats in the showers and bathing area for safety. Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen stored in the laundry room. Medications, First-Aid Kit & Book: The medications are centrally stored and locked in the medication station and is only available for staff to use but inaccessible to clients. LPA also reviewed the first aid kit and it included all the required supplies and the book is also updated. Med Tech Angelica Lopez provided files for review

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 395-3554
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022

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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CORAL OAKS CARE LIVING	FACILITY NUMBER: 198602099
	VISIT DATE: 07/21/2022

NARRATIVE

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Clients & Staff Files:
The resident’s files are stored and locked at the medication station and the staff files are stored in the administrator office. On today's visit, LPA reviewed eight (7) staff files and all have required documents include current first aid certificate and required training hours. LPA also reviewed nine (7) residents files and all included updated needs and service plan, admission agreement and physician report and TB test result. The administrator is Eleanor Barrientos and her administrator certificate will be expired on 06/17/2023. For Resident's P&I, LPA reviewed (7) P&I records and the records are updated and accurate.
Emergency Phone Numbers, Exit Plan & Menu:
Posted & readily available for review in the outside of the multipurpose room and the hallway. The facility has total of 20 Fire Extinguishers, and they are all fully charged
Food Service
Dishes, cups and flat ware are stored in the kitchen and inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are stored in the kitchen which residents are not allowed to go into the kitchen. Food supply adequate stored in the kitchen and consists of the following: 2 days perishable and 7 days non-perishable. Dishwasher in kitchen properly installed and functioning.
Smoke Detectors:
Each bedroom and common area has smoke detectors and carbon monoxide detectors and they are all interconnected, and they are all working properly.
Appliances:
Stove burners, oven, microwave, washer, and dryer are all operational. There are four (4) refrigerators and two (2) freezer in the facility for additional food storage. One (1) refrigerator is not being used sign posted repair is scheduled.
Toxins:
All the cleaning solutions are locked and stored in the janitor closet which are inaccessible for residents.
Water Temperature:
The hot water temperature tested at the 10 bathrooms that LPA inspected between varied between 110-118 degrees within the regulation limits.
Fire Drill:
The last fire drill was conducted on 06/25/22

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time.

An exit interview conducted with Administrator Eleanor (Ellen) Barrientos, a copy of report provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 395-3554
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022

LIC809 (FAS) - (06/04)

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