198602229-8-27-2022-11-AS-LMOA-CHPR4P-20220827124152

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602229
Report Date: 08/27/2022
Date Signed: 08/27/2022 12:42:10 PM

Document Has Been Signed on 08/27/2022 12:42 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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	ARLINGTON POST GUEST HOME		FACILITY NUMBER:	198602229
ADMINISTRATOR:	LACANILAO, LAUREANA		FACILITY TYPE:	740
ADDRESS:	1433 POST AVE		TELEPHONE:	(310) 328-6086
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90501
CAPACITY:	6	CENSUS: 4	DATE:	08/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Laureana Lacanilao/JM Demafelix		TIME COMPLETED:	12:30 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	On 8/27/2022, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. Upon arrival at the facility, LPA Montoya called the facility, spoke with Administrator Laureana Lacanilao and conducted a risk assessment. Based on the assessment, the facility is clear of Covid-19 infection. LPA met with Administrator Laureana Lacanilao and explained the purpose of today’s visit. Area Manager JM Demafelix arrived later and joined the visit. The facility is licensed for six (6) non-ambulatory residents which six (6) may be bedridden and a hospice waiver for two (2) residents; prefers to serve elderly age 60 and above. The facility is a single-story structure located in a residential neighborhood. The facility consists of a foyer, kitchen, dining area, living room, fire place, office area, laundry room, five (5) resident bedrooms, one staff bedroom, three and a half (3 1/2) bathrooms (located in resident bedrooms), one shared bathroom, two-car garage and a covered front patio. The facility does not handle residents cash resources. Facility annual fees are current during today’s visit. LPA Montoya toured and inside and outside grounds of the facility with Administrator Laureana Lacanilao. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 112.4 degrees F. A comfortable temperature of 75 degrees was maintained in the facility. Evaluation Report Continues on LIC 809-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2022

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: ARLINGTON POST GUEST HOME	FACILITY NUMBER: 198602229
	VISIT DATE: 08/27/2022

NARRATIVE

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LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. The facility has (2) fire extinguishers that were charged, smoke detectors, and carbon monoxide were operable. The facility conducted a Fire/Safety Drill on 8/11/22. A working telephone remains (310-328-6086 available.

During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for residents, staff and visitors, and sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has an approved Mitigation Plan Report on file with CCLD.

Advisory Notes - Technical Assistance were issued, please see LIC9102-AN.

The following deficiency were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency may result in civil penalties. Exit interview conducted and appeal rights discussed. A copy of this report and appeal rights provided to Area Manager JM Demafelix.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/27/2022 12:42 PM - It Cannot Be Edited

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: ARLINGTON POST GUEST HOME	FACILITY NUMBER: 198602229
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87208(a)(7)(B)

Plan of Operation (a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: (7) Sketches,, showing dimensions, of the following: (B) The grounds showing buildings, driveways, fences, storage areas, pools, gardens, recreation are and other spaces used by the residents. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview. the licensee did not comply with the section cited above. LPA observed a large covered patio attached to the front area of the facility which is not reflected in the original facility sketch. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/09/2022
	Plan of Correction
1 2 3 4	Administrator shall submit an updated facility sketch and an updated plan of operation stating the use of the newly installed covered patio. Administrator shall also ensure to inform CCLD prior to any constructions in the facility. POC shall be submitted to CCLD via email to lourdes.montoya@dss.ca.gov

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2022

LIC809 (FAS) - (06/04)

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