198602278-3-14-2022-11-AS-LMOA-CCHV6T-20220314161004

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602278
Report Date: 03/14/2022
Date Signed: 03/14/2022 04:10:12 PM

Document Has Been Signed on 03/14/2022 04:10 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
MONTERY PARK, CA 91754

FACILITY NAME:	ALL HEARTS RESIDENTIAL HOME		FACILITY NUMBER:	198602278
ADMINISTRATOR:	FERNANDEZ, CARMEN V		FACILITY TYPE:	740
ADDRESS:	2265 W 237TH STREET		TELEPHONE:	(310) 530-5380
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90501
CAPACITY:	6	CENSUS: 5	DATE:	03/14/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:39 AM
MET WITH:	Remedios Turla		TIME COMPLETED:	03:30 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 3/14/2022, Licensing Program Manager (LPM) Angela Kendrick, Licensing Program Analysts (LPAs) Lourdes Montoya, and Antonia Alvizar conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. Upon arriving at the facility, LPAs and LPM met with House Manager (HM) Remedios Turla and Caregiver Ernesto Singian. LPAs and LPM were granted access and allowed to enter the facility to conduct an inspection by HM Turla. LPA Montoya explained the purpose of today’s visit. The facility is licensed for six (6) non-ambulatory residents which one (1) may be bedridden and a hospice waiver for two (2) residents; prefers to serve elderly age 60 and above. The facility consists of a kitchen, dining room, living/entertainment room, office area, four (4) resident bedrooms, two (2) bathrooms (one ensure bathroom in bedroom #3), washer and water heater in the hallway closet, dryer in garage, and backyard patio. Currently, there are 5 non-ambulatory residents of which one has dementia, no residents on hospice during today’s visit. The facility does not handle residents’ cash resources. Facility annual fees are current during today’s visit. LPAs and LPM toured the inside and outside grounds of the facility with HM Turla. There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for client 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 108.0 degrees F in the common bathroom and 106.6 degrees F in the ensuite bathroom #2. A comfortable temperature of 71 degrees F was maintained in the facility. Report continued in LIC809-C

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (323) 981-4934
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022

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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Document Has Been Signed on 03/14/2022 04:10 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
MONTERY PARK, CA 91754

FACILITY NAME: ALL HEARTS RESIDENTIAL HOME	FACILITY NUMBER: 198602278
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87705(f)(1)

Care of Persons with Dementia

(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPAs' and LPM's observations and interviews, the licensee did not comply with the section cited above. The water heater stored in the hallway closet is accessible to Resident #1 who has dementia. This poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/15/2022
	Plan of Correction
1 2 3 4	Licensee shall ensure the water heater is inaccessible to Resident #1 who has a dementia. The water heater must be locked and inaccessible. Licensee shall send a proof of correction to Lourdes.Montoya@dss.ca.gov by 3/15/22.

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: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (323) 981-4934
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/14/2022 04:10 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
MONTERY PARK, CA 91754

FACILITY NAME: ALL HEARTS RESIDENTIAL HOME	FACILITY NUMBER: 198602278
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87303(a)

The facility shall be clean, safe and sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPAs' and LPM's observations and interviews, the licensee did not comply with the section cited above. The cabinets/shelves in both bathrooms are decentegrated/broken; the faucet handle in the common bathroom is broken; molded shower head; window screen in bathroom #2 is broken and molded. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/21/2022
	Plan of Correction
1 2 3 4	Licensee shall repair or replace the decentegrated/broken cabinets/shelves, broken faucet handle, molded shower head, and window screen. Licensee shall send a proof of correction to Lourdes.Montoya@dss.ca.gov by the POC due date.

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: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (323) 981-4934
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022

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
MONTERY PARK, CA 91754

FACILITY NAME: ALL HEARTS RESIDENTIAL HOME	FACILITY NUMBER: 198602278
	VISIT DATE: 03/14/2022

NARRATIVE

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LPAs and LPM observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, and toxins were stored and not accessible to clients. The kitchen was inspected and there is sufficient perishable and non-perishable food available. Two fire extinguishers are charged and last serviced on 10/26/2021, one (1) carbon monoxide unit is operable. A landline telephone (310) 530-5380 was available and operable.

Medications are locked & centrally stored in a cabinet near the kitchen. The first aid kit has all required supplies.

During the visit, LPAs and LPM observed the following: facility's infection control practices; screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms; every staff was wearing a face covering; the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has a Mitigation Plan Report approved by CCLD.

The following deficiencies were observed:
The water heater stored in the hallway closet is accessible to Resident #1 with dementia.
Decentegrated/broken presswood shelves/cabinet in both bathrooms.
Broken and molded bathroom window screen in bedroom #3.
Molded shower head.

The above deficiencies were cited (see LIC 809D) from the California Code of Regulations, Title 22. Exit interview conducted and appeal rights discussed. A copy of this report and appeal rights provided to the HM Remedios Turla.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (323) 981-4934
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022

LIC809 (FAS) - (06/04)

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