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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602543
Report Date: 07/27/2021
Date Signed: 07/27/2021 11:39:15 AM

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:AURAFACILITY NUMBER:
198602543
ADMINISTRATOR:PINCHES III, JOHN LFACILITY TYPE:
740
ADDRESS:5602 WHITEWOOD AVETELEPHONE:
(310) 933-8275
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY:6CENSUS: 4DATE:
07/27/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jiezl Mate - Lead CaregiverTIME COMPLETED:
11:43 AM
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An unannounced Plan of Correction visit was conducted by Licensing Program Analysts (LPAs) Luis Mora and David Sicairos to ensure the deficiency cited on 07/01/21 during a unannounced case management visit was corrected. LPA met with Lead Caregiver Jiezl Mate and explained the reason for the visit.

87608 Postural Supports: a) Based on the individual's preadmission appraisal,... Postural supports may be used under the following conditions. (3) A written order from a physician... shall be maintained in the resident’s record...Based on LPA's observation and documents reviewed facility did not ensure R5 has a physician written order for half bed rails on file, LPA observed R5 has half be rails on his bed which poses an immediate Health, Safety, or Personal rights risk to persons in care.

On 07/08/21 LPA Flores received the physician written order for the half bed rails of resident #5 (R5).


Deficiency was cleared prior to today's visit. Exit interview held, and a copy of this report was provided.
SUPERVISOR'S NAME: Rebecca OrendainTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Luis MoraTELEPHONE: 323-981-4934
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
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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