198603118-9-7-2022-11-AS-ASOO-CHZUSG-20220906155019

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603118
Report Date: 09/06/2022
Date Signed: 09/07/2022 08:59:50 AM

Document Has Been Signed on 09/07/2022 08:59 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:	CLEARWATER AT SOUTH BAY		FACILITY NUMBER:	198603118
ADMINISTRATOR:	JILL TUCKER		FACILITY TYPE:	740
ADDRESS:	3210 & 3212 W SEPULVEDA BLVD		TELEPHONE:	(424) 488-6340
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90505
CAPACITY:	137	CENSUS: 117	DATE:	09/06/2022
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Michele Johnson, Executive Director		TIME COMPLETED:	04:00 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	Licensing Program Analyst (LPA) Ana Soto conducted a POC unannounced visit to the above facility. LPA was met by Michele Johnson, Executive Director and the purpose of the visit was explained. LPA Soto conducted a complaint visit on 04/08/22 and substantiated allegation - Facility Facility A/C is in disrepair. At that time facility A/C was only working on certain sections of the Assisted Living Building. The A/C had not worked for more than 2 months. The facility had been trying to repair the A/C unit and was waiting on a part that unfortunately was on back order. They were not sure how long it would take to have the entire main A/C unit repaired. The only areas that the A/C were not working in are the residents rooms. Rooms #112, 206, 207, 209, and 224. LPA asked the facility to provide those rooms and any other rooms that might be affected in the future with personal electrical fans. The facility provided the personal fans for the rooms that are being affected at that time. LPA verified that the A/C was not working in the rooms. On Today's visit 09/06/22, LPA interviewed executive director and toured both buildings. The Executive Director has only just started working at the facility about 3 weeks ago. Since she has been at the facility, the facility has already purchased and/or rented 20 portable A/C units for the residents and the common areas to have A/C, in the meantime they repair the main A/C unit for both buildings. Within the last 2 weeks they have been purchasing portable A/C for those resident that request them and that say they are hot. The facility has 90 rooms combining both buildings to get portable A/C units for. They have already purchased 10 more portable A/C units,that will be arriving tomorrow 09/07/22. The facility has requested a bid to purchase 30 more A/C portable units for the remaining rooms. The following areas in the AL side do not have the A/C. On the 1st floor is the west side of the building which are:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

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: CLEARWATER AT SOUTH BAY	FACILITY NUMBER: 198603118
	VISIT DATE: 09/06/2022

NARRATIVE

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The lobby, hallway leading to memory care, rooms 115 -126. On the 2nd floor is the west side of the building which are rooms 215 - 226 and activity room, medication room, and laundry room.

In the memory care building, the east side of the building has already working A/C which include the 3 floors of the building. The contractor that is working on the A/C right now is AMC HVAC. The facility has requested 2 bids from outside contractor's to replace the main A/C unit for both buildings. They have already received one bid from one contractor to replace the entire A/C main unit. They are awaiting 2nd contractor's bid to come in the end of week Friday 09/09/22. The 2 buildings main A/C unit still remains unrepaired and now includes memory care building. Which the A/C is out too. The current temperature is 82.4.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA observed the following deficiency and issued a citation.

An exit interview was conducted with Michele Johnson and a copy of report and Appeal Rights were provided via email due to technical difficulties (printer not working.)

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/07/2022 08:59 AM - It Cannot Be Edited

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: CLEARWATER AT SOUTH BAY	FACILITY NUMBER: 198603118
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/06/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/20/2022 Section Cited	1 2 3 4 5 6 7	87303(b) A comfortable temperature for residents shall be maintained at all times. This was not met as evidence by; based on the observations and interviews the facility had A/C not completely operational and still remians unreapired. This poses a potential risk for persons in care.
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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: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

LIC809 (FAS) - (06/04)

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