198602861-10-3-2022-11-AS-DSEA-CJUUQ4-20221003154630

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602861
Report Date: 10/03/2022
Date Signed: 10/03/2022 03:48:25 PM

Document Has Been Signed on 10/03/2022 03:48 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	BEST PLACE HOME CARE		FACILITY NUMBER:	198602861
ADMINISTRATOR:	NAMOC, MARYLOU		FACILITY TYPE:	740
ADDRESS:	23736 PRESIDENT AVENUE		TELEPHONE:	(310) 784-1986
CITY:	HARBOR CITY	STATE: CA	ZIP CODE:	90710
CAPACITY: 6		CENSUS: 6	DATE:	10/03/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:27 AM
MET WITH:	House Manager/Veronica Gratil - Administrator/Marylou Namoc		TIME COMPLETED:	01:00 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 10/03/2022, Licensing Program Analyst (LPA) Don Senaha and LPA Mario Leon conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA met with House Manager Veronica Gratil and was later joined by Administrator Marylou Namoc and explained the purpose of today’s visit. The facility is licensed to operate for six (6) non-ambulatory elderly residents ages 60 and above. The facility is approved for one (1) bedridden and two (2) hospice. The facility is a single-story structure located in a residential neighborhood. The facility consists of the following: five (5) resident's rooms, two (2) bathrooms, a living room area, dining area and kitchen. There is an attached garage with access through the door prior to entering the facility or the garage door. The washer and dryer are located in the garage. There is a shaded patio area with ample seating area for the residents. LPAs and administrator toured the physical plant. There are no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting 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 between 112.1 F to 113.2 F in the kitchen and bathrooms. A comfortable temperature was maintained in the facility. Evaluation Report Continues on LIC 809-C

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Don Senaha
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 5

Document Has Been Signed on 10/03/2022 03:48 PM - It Cannot Be Edited

Created By: Don Senaha On 10/03/2022 at 12:32 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: BEST PLACE HOME CARE	FACILITY NUMBER: 198602861
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/03/2022

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 observation, the licensee did not comply with the section cited above. LPA observed two (2) knives in dishwasher and a scissors in an unlocked drawer which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/04/2022
	Plan of Correction
1 2 3 4	LPAs witnessed Licesee immediately removing and locking knives and scissors making them inaccessible to residents during visit.

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:

Ulysses Coronel

LICENSING EVALUATOR NAME:

Don Senaha

LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: BEST PLACE HOME CARE	FACILITY NUMBER: 198602861
	VISIT DATE: 10/03/2022

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
26
27
28
29
30
31
32

LPAs 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 residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Three (3) fire extinguishers were fully charged, one in the kitchen area, one in the hallway and one in the garage. First aid kit was available. Smoke detectors and carbon monoxide were operable. A review of Medication Administration Records (MAR) was maintained in order and accurate.

During the visit, LPAs observed the facility infection control practices. LPAs observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed most staff wearing face coverings, LPA observed six (6) clients and three (3) staff present during the tour. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted.

Advisory Notes – Two (2) Technical Assistance were issued, please see LIC9102-AN.

There was one deficiency cited during this inspection visit. See LIC 9099D page.

An exit interview was conducted and a copy of this report was provided to Administrator Marylou Namoc.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Don Senaha
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

LIC809 (FAS) - (06/04)

Page: 5 of 5