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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602866
Report Date: 04/01/2022
Date Signed: 04/01/2022 04:23:01 PM


Document Has Been Signed on 04/01/2022 04:23 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:SENIOR MANOR CARE IIFACILITY NUMBER:
198602866
ADMINISTRATOR:GRADNEY, ANGELIQUEFACILITY TYPE:
740
ADDRESS:1851 REDONDELA DRIVETELEPHONE:
(310) 989-1941
CITY:RANCHO PALOS VERDESSTATE: CAZIP CODE:
90275
CAPACITY:6CENSUS: 4DATE:
04/01/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:09 PM
MET WITH:Charles AbadTIME COMPLETED:
04:20 PM
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On 04/01/22 Licensing Program Manager Conducted a case management in regards to Complaint Control # 11-AS-20200703110054.

LPA Jordan observed the facility heating and air conditioning to be in working condition, and the temperature
to be comfortable. Interviews with residents in care also indicated that they were comfortable.
LPA Gave a technical advisory for no thermostat to ensure that temperature setting stays with the regulation within the home Per : 87303 Maintenance and Operation

(b)A comfortable temperature for residents shall be maintained at all times.
(1)The facility shall heat rooms that residents occupy to a minimum of 68 degree F, (20 degrees C). (2)The facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature.

Technical Advisory was given regarding PIN 22-07-ASC, which requires that at all times the licensee provide assistance for arranging alternative communication for visitors such as video calls and online communications As of January 1st 2022 Licensee's must have internet access, and must provide at least one internet accessible device, such as a computer, smart phone, tablet that is equipped with video conferencing. The device must be available in a manor that allows client or resident to access it for personal personal or confidential manor, and be available for all residents/ clients in the facility within reasonable hours.


SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade JordanTELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:
DATE: 04/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/01/2022
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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