198603198-9-30-2024-11-AS-ZBRN-D9LRWS-20240930132337

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603198
Report Date: 09/30/2024
Date Signed: 09/30/2024 02:39:36 PM

Document Has Been Signed on 09/30/2024 02:39 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:	BRIGHTEN COTTAGES - PARKCREST		FACILITY NUMBER:	198603198
ADMINISTRATOR:	ROMAN, ELSA		FACILITY TYPE:	740
ADDRESS:	5818 E PARKCREST STREET		TELEPHONE:	(562) 452-7409
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90808
CAPACITY:	6	CENSUS: 6	DATE:	09/30/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:16 AM
MET WITH:	Jose Umana, Administrator		TIME COMPLETED:	01:45 PM

NARRATIVE

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On 09/30/2024 at 09:11am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one year inspection. LPA met with Jose Urmana , Administrator and the purpose of the visit was discussed. The facility is licensed to serve 6 non- ambulatory of which 1 may be bedridden (bedroom #5 approved for bedridden) and approved for two (2) hospice waivers. The two (2) of the residents are diagnosed with dementia, two (2) hospice, one (1) home health resident and zero (0) bedridden resident. The facility does not handle any of the residents’ money. The facility have a balance of $0 for annual fees. The last fire drill was conducted on 03/13/2024.
The Certificate of Liability is valid from 08/01/2024 - 08/01/2025.

The home is a single story home consisting of: (6) resident bedrooms, (4) full bathrooms, living room, kitchen with dining area, laundry room (located in the hallway) and an outdoor shaded patio area. LPA Brown toured the resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured in kitchen at 111.3F and bathrooms #1 - # 4 at 115.1 F. 111.4, 109.9 F, 110.0 F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions.

Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises.

Discrepancies were observed and documented on 809-D page .

An exit interview conducted, appeal rights explained, and a copy of this report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Zina Brown	TELEPHONE: 424-544-1075
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024

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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Document Has Been Signed on 09/30/2024 02:39 PM - 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BRIGHTEN COTTAGES - PARKCREST	FACILITY NUMBER: 198603198
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87465(a)(6)

87465 Incidental Medical and Dental Care A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above as during medication reviews, LPA observed documentation on the MAR indicating if residents refused or missed taking medication throughout the week which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/14/2024
	Plan of Correction
1 2 3 4	The administrator will ensure a in-service training regard medication documentation is completed by POC due date and provide proof of in-service training for all staff via email at zina.brown@dss.ca.gov

Type B

Section Cited

CCR

87458(b)(5)

The medical assessment shall include, but not be limited to: The determination whether the person is ambulatory or nonambulatory as defined in Section 87101(a) or (n), or bedridden as defined in Section 87455(d). The assessment shall indicate whether nonambulatory status is based upon the resident’s physical condition, mental condition or both. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on records review, 1 of the resident records review, indicated on the physicians record, the residences are bedridden. Based on LPA observation and other records reviewed, resident does not appear to be bedridden. This poses as a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/30/2024
	Plan of Correction
1 2 3 4	The administrator shall clarify residence ambulatory status to determine if the residence are bedridden or non-ambulatory. The facility will submit proof of updated physician report by POC due date via email at zina.brown@dss.ca.gov

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: (424) 544-1027
LICENSING EVALUATOR NAME: Zina Brown	TELEPHONE: 424-544-1075
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024

LIC809 (FAS) - (06/04)

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