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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602887
Report Date: 04/18/2024
Date Signed: 04/18/2024 04:40:42 PM


Document Has Been Signed on 04/18/2024 04:40 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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245



FACILITY NAME:SUNRISE ASSISTED LIVING OF HERMOSA BEACHFACILITY NUMBER:
198602887
ADMINISTRATOR:ERIC K MENSAHFACILITY TYPE:
740
ADDRESS:1837 PACIFIC COAST HWYTELEPHONE:
(310) 937-0959
CITY:HERMOSA BEACHSTATE: CAZIP CODE:
90254
CAPACITY:142CENSUS: 100DATE:
04/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Administrator Anita Csukardi,TIME COMPLETED:
05:00 PM
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On 04/18/2024 at 8:00 am Licensing Program Analyst (LPA) David España conducted an unannounced Required-1-year annual visit. Upon arrival at the facility, LPA España conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection (No COVID-19 cases). LPA España verified that the facility has an approved mitigation plan report. LPA España was granted access and allowed to enter the facility to conduct the inspection. LPA met with Anita Csukardi, Executive Director and explained the purpose of the visit. There are Seventy-Eight (78) residents in the facility, 61 residents are ambulatory, and 16 are non-ambulatory. The facility is a two-story structure with underground parking located in a residential neighborhood. The facility consists of (94) bedrooms, (99) full bathrooms including common area restrooms, 1st floor consist of: 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.)
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2024
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


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: SUNRISE ASSISTED LIVING OF HERMOSA BEACH
FACILITY NUMBER: 198602887
VISIT DATE: 04/18/2024
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LPA and Executive Director Anita Csukardi, toured the facility inside and out. LPA observed all walkways to be clean, clear and free from obstructions, hazards and debris. LPA did not observe any bodies of water on the premises. LPA observed the facility to be in good repair. LPA toured rooms on both floors and found they contained the required furniture. All rooms were spacious and had storage to accommodate resident’s belongings. LPA observed ample lighting in rooms. Resident's have the option to furnish rooms with their own belongings. LPA checked bathrooms in rooms toured and public restrooms. All bathrooms observed were clean and sanitary. All showers were free of mold and mildew. LPA observed all bathrooms to have secured handrails and not skit mats or chairs for the shower. LPA observed the kitchen to be clean and sanitary. LPA observed a 3-day supply of perishable foods and 7-day nonperishable foods. LPA observed all appliances to be in good repair. LPA observed an ample supply of cutleries, pots and pans to be in good repair. All knives and sharps are secured and inaccessible to residents.
All beds observed had the required linens, including mattress cover, fitted sheets, blankets, comforters, pillows, and pillowcases. Residents had an ample supply of personal hygiene supplies.LPA toured all common rooms and areas. All walkways and hallways were clean, clear, and free of hazards and obstructions. LPA observed ample seating to accommodate residents in all common rooms. The facility was maintained at a comfortable temperature. LPA observed ample lighting in all walkways and common rooms. LPA observed resident’s doing activities, playing games, and watching music performers. All smoke detectors and carbon monoxide detectors are in compliance and operational. LIC809C Continued
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: SUNRISE ASSISTED LIVING OF HERMOSA BEACH
FACILITY NUMBER: 198602887
VISIT DATE: 04/18/2024
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LPA observed the First aid kit and found it to fully stocked of the required items, with manual. There are no firearms or ammunition stored at the facility. All hazardous toxins are inaccessible to residents. LPA observed all exits, walkways and/or passageways to be clean, clear, and free of debris and hazards. All medications are stored in the Med Room and are secured and inaccessible to residents. LPA reviewed medications for Six (6) out of Seventy-Eight (78) residents and matched them to the eMARs. LPA observed all medications to be in their original packaging. LPA reviewed Eight (8) out of Seventy-Eight (78) residents files and found they contained the required documentation. LPA reviewed the executive directors and 7 Staff files and found they contained the required documents, training and certification. LPA reviewed and received a copy of the facilities Liability Insurance, Plan of Operations (Dementia plan, Admission policies and Incidental Medical and Dental Care), activity schedule, meal menu, resident and family council meeting notice and notes, Advertisement and marketing/promotional material, and admission/intake packet. LPA conducted 7 interviews with residents. All residents had nothing but good things to say about the facility and staff. LPA conducted 4 interviews with staff.
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. The generator is tested and ran weekly. LPA reviewed the facility’s Emergency and Disaster Plan (LIC610E). LPA observed all required postings.

LIC809C Continued

SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
LIC809 (FAS) - (06/04)
Page: 5 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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: SUNRISE ASSISTED LIVING OF HERMOSA BEACH
FACILITY NUMBER: 198602887
VISIT DATE: 04/18/2024
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Fire alarm system is monitored by private company and was last inspected on March 13, 2024.

LPA observed (12) fire extinguishers fully charged last serviced on 02/05/2024

The last emergency drill was conducted on 04/18/2024.

There was one Technical Assistance provided on today's visit.

Resident Rights/Information - Technical Assistance: 87468(c)(2)(A)

An exit interview conducted with Anita Csukardi, Executive Director and a copy of this report was provided.

SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5