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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602192
Report Date: 09/26/2023
Date Signed: 09/26/2023 11:08:17 AM


Document Has Been Signed on 09/26/2023 11:08 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:SAKURA GARDENS AT LOS ANGELESFACILITY NUMBER:
198602192
ADMINISTRATOR:KONISHI, DANIELFACILITY TYPE:
740
ADDRESS:325 S BOYLE AVETELEPHONE:
(323) 263-9651
CITY:LOS ANGELESSTATE: CAZIP CODE:
90033
CAPACITY:177CENSUS: 132DATE:
09/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:46 AM
MET WITH:Daniel Konishi - Executive DirectorTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Tena Herrera conducted a Case Management Visit for Change of capacity. LPA explained the purpose of today's visit to Daniel Konishi - Executive Director who assisted with this visit.

The facility’s physical plant sketch was provided. Licensee applied for the change the capacity from 177 to 183 non-ambulatory residents. Fire inspection was conducted and fire clearance was approved for 183 non-ambulatory elderly residents ages 60 and over, of which 47 may be bedridden. Per Daniel Konishi of the 183 non-ambulatory residents, 24 residents will be in Transitional Memory Care Units, 23 residents in Memory Care Units and the rest (136) in Assisted Living.

During today's visit LPA toured the Transitional Memory Care area of facility. LPA inspected the facility per the updated physical plant sketch and granted fire clearance. Tour of the Transitional Memory Care Units included 13 rooms, dining/activity room, court yard and delayed egress system. Rooms 119-124 did not have proper furnishing to accommodate residents comfortably (bed, dresser, lamp, chair, shower curtain etc), air Conditioner cover in rooms 120 &119 were not properly secured, room 123 was observed to have debris and boxes, dining area did not have proper dining wear (plates, cups, utensils), and proper amount of linens were not available.

No deficiencies were observed regarding the application for the change of capacity during this visit. Due to the observations listed above LPA could not approve capacity increase at this time and will have to return at a later date, Executive Director was instructed to contact licensing once corrections have been made. Exit interview was held and a copy of the report was provided to Rodora Marina Merana - Memory Care Director.
SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena HerreraTELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2023
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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