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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602264
Report Date: 11/17/2023
Date Signed: 11/17/2023 10:27:25 AM


Document Has Been Signed on 11/17/2023 10:27 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:TERRAZA COURTFACILITY NUMBER:
198602264
ADMINISTRATOR:GREG BECKERFACILITY TYPE:
740
ADDRESS:10955 WASHINGTON BLVDTELEPHONE:
(310) 838-7800
CITY:CULVER CITYSTATE: CAZIP CODE:
90232
CAPACITY:115CENSUS: DATE:
11/17/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Jasmine Hezar/Executive DirectorTIME COMPLETED:
10:27 AM
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On 11/17/2023 Licensing Program Analyst-LPA Alfonso Iniguez conducted an unannounced case management visit. LPA Iniguez met with Jasmine Hezar/Executive Director. LPA Iniguez informed her the purpose for today's visit was to tour the entire facility for the capacity increase requested by licensee.

LPA Iniguez and Administrator made a complete tour of the facility. The facility is a three-story commercial building. The facility consists of the following: The first-floor Lobby/receptionist area, Executive Director's office, Business office, copy area, Marketing office, living room, library/activity room, cafe/bistro/latte/water area, public/visitor restrooms, hair salon, life enrichment/activity office, storage rooms, dining room, commercial kitchen, staff restrooms, commercial laundry room, resident's laundry room, Director of Nursing office, medication room, employee's lounge, emergency food, mechanical room, electrical room, 3 storage rooms, and attached underground security parking garage.

The second floor consists of residents’ bedrooms and bathrooms, storage closets, and patio. The Memory Care Unit (MCU) consists of bedrooms and bathrooms, resident's laundry room, dining room/activity room, small kitchen, living room/TV room, shower room, Memory Care Coordinator office, small living room, storage room, and MCU patio. The third floor consisted of bedrooms and bathrooms, resident's laundry room, small living room/TV room.

Report continues on LIC 809C.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2023
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: TERRAZA COURT
FACILITY NUMBER: 198602264
VISIT DATE: 11/17/2023
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The licensee is requesting a capacity increase from 115 to 170 (160 non-ambulatory residents and 10 bedridden). LPA Iniguez observed the facility bedrooms for the capacity increase.


On 11/06/2023 LPA Iniguez received an email from Fire Inspector/Fire Investigator-Noah Piechowski. The Fire Clearance was granted and approved for 170 (160 non-ambulatory and 10 bedridden).


LPA Iniguez will make recommendations to her LPM Eva Alvarez for a capacity increase.



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

An exit interview was conducted, and a copy of the Facility Evaluation Report and Appeal Rights was provided to the Executive Director/Jasmine Hezar.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
LIC809 (FAS) - (06/04)
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