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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603162
Report Date: 01/20/2022
Date Signed: 01/20/2022 03:54:46 PM

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:WHITTIER GLEN ASSISTED LIVINGFACILITY NUMBER:
198603162
ADMINISTRATOR:ATEAIAN, KIMIAFACILITY TYPE:
740
ADDRESS:10615 JORDAN RDTELEPHONE:
(562) 943-3724
CITY:WHITTIERSTATE: CAZIP CODE:
90603
CAPACITY:93CENSUS: 55DATE:
01/20/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator Sophia Chan and Wellness Director Brooke LamaonteTIME COMPLETED:
01:00 PM
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An informal conference was held via Microsoft Teams on 1/20/2022. The purpose of this informal meeting was to discuss the facility staffing issues.

Present in the meeting were: Licensing Program Analyst (LPA) Jose Villalobos, Regional Manager (RM), Facility Administrator Sophia Chan and Wellness Director Brooke Lamaonte.

Licensing was informed that on 1/15/22, there were staffing shortages in the facility that led to there being only 1 med tech/ care giving staff for all residents of the facility. Sophia and Brooke explained that it was a one time incident due to miscommunication between staff and staff testing positive for covid-19 that coverage was not done at a timely matter. The facility did acquire more staff to cover shifts. Sophia and Brooke explained that the facility has recently opened a new position focused on showering residents that would serve as an additional caregiver staff when needed in order to be more prepared.

Licensing informed Sophia and Brooke that they are able to reach out to Licensing regarding staffing issues.
LPA to forward the following PINS for administrator to review:
PIN 22-04 ASC
PIN on 21-32.1 ASC

Community Care Licensing (CCL) reminded Administrator that Department of Public Health Guidelines must be followed as well CCL's regulations to remain in compliance otherwise citations may be warranted.

No deficiency was issued during today's meeting. An exit interview was conducted and a copy of this report was emailed to Administrator for signature.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2022
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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