198602887-9-12-2022-11-AS-ASOO-CJ7LSK-20220912090049

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602887
Report Date: 09/11/2022
Date Signed: 09/12/2022 09:01:01 AM

Document Has Been Signed on 09/12/2022 09:01 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	SUNRISE ASSISTED LIVING OF HERMOSA BEACH		FACILITY NUMBER:	198602887
ADMINISTRATOR:	ODISHOO, JANELLE		FACILITY TYPE:	740
ADDRESS:	1837 PACIFIC COAST HWY		TELEPHONE:	(310) 937-0959
CITY:	HERMOSA BEACH	STATE: CA	ZIP CODE:	90254
CAPACITY: 142		CENSUS: 79	DATE:	09/11/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Ami Mehta, Executive Director		TIME COMPLETED:	04:00 PM

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Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual required and infection control visit to the above facility. LPA met with Edith Duru, Reminiscence Coordinator and later met with Ami Mehta, Executive Director and the purpose of today’s visit was explained.

There are currently 79 residents in the facility. (?) residents are ambulatory, (?) are non-ambulatory, (?) bedridden. The facility is a two-story structure with underground parking located in a residential neighborhood. It consists (94) bedrooms, (99) full bathrooms including common area restrooms, 1st floor consist: lobby, bird room, TV room, copy room, storage room, fire control room, dining room, bistro, kitchen, main laundry room, chemical room, resident laundry room, staff lounge, physical therapy/gym room, 2 lounge areas. Reminiscence Unit: storage room, electrical room, chemical closet, laundry room, living room /office, life skill area, kitchenette, dining room, bathtique, and balcony. 2nd floor: Resident laundry room, lounge, hair salon, activity room, storage area, electrical room, housekeeping room, bathtique, medication room, and lounge. Shaded middle patio, enclosed front porch area, underground parking (P1.)

LPA, Edith, and Ami toured the entire facility inside and out. Documents are posted as mandated. 79 Bedrooms are occupied by residents and contain the mandated furniture. The (94) bathrooms have grab bars and non-skid mats and are clean and operational. First aid kit is fully stocked with manual; smoke detectors and carbon monoxide detector were in compliance and operational. Fire alarm system is monitored by private company. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. (5) Resident file along with medications are current. (5) Staff file is current. Ample supply of perishable and nonperishable food, hot water temperature is (108.3) degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, (12) fire extinguisher are fully charged. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2022

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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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
MONTEREY PARK, CA 91754

FACILITY NAME: SUNRISE ASSISTED LIVING OF HERMOSA BEACH	FACILITY NUMBER: 198602887
	VISIT DATE: 09/11/2022

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During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry & visitors and temperatures are logged and checked, sanitizer/soap, paper towels, in all the bathrooms and additional sanitation supplies are stored in P1. LPA observed staff wearing masks, resident private rooms will be converted to isolation rooms (if needed) trash cans with lids, cart for PPE’s, mitigation plan posted and/or in folder, Fit testing completed for staff, and required postings throughout the facility. Visitor designated area, facility has internet & IPAD for residents to use, resident’s temperatures are checked and logged (once a day). Emergency contacts updated and posted; PPE's are enough for 30 days.

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

No technical Advisory (TA) issued.

An exit interview conducted with Ami Mehta, Executive Director.

Due to technical difficulties (printer not working) reports provided via email.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2022

LIC809 (FAS) - (06/04)

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