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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603220
Report Date: 09/19/2024
Date Signed: 09/19/2024 03:44:15 PM

Document Has Been Signed on 09/19/2024 03:44 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:CITY VIEW LA, LLCFACILITY NUMBER:
198603220
ADMINISTRATOR/
DIRECTOR:		GINSBERG, MENDYFACILITY TYPE:
740
ADDRESS:515 N LA BREA AVETELEPHONE:
(323) 938-2131
CITY:LOS ANGELESSTATE: CAZIP CODE:
90036
CAPACITY: 166CENSUS: 105DATE:
09/19/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:34 AM
MET WITH:Mendy GinsbergTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 09/19/23 Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced subsequent annual required visit using the CARE Inspection Tool. This visit is a continuation of the last visit LPA made on 09/09/24. LPA met with Administrator Mendy Ginsberg, and explained the purpose of today’s visit. The facility is licensed to operate for (166) non-ambulatory elderly adults of ages 60 and above. The facility is approved for (14) hospice residents.

The facility is a six-story structure located in a commercial neighborhood. It consists of (21) resident bedrooms in Memory Care and (71) resident bedrooms in Assisted Living, with a bathroom in each unit. There is an activity room, a dining area, a private dining room, a kitchen, a rooftop patio, a lobby, (8) public restrooms, a gym, and a subterranean parking lot.

LPA and Business Office Manager, Venita Harris toured the physical plant on 09/09/24 but due to time constraints were unable to fully inspect the entire facility. On 09/19/24, LPA and Mendy Ginsberg conducted another full inspection of the entire physical plant. There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. Bed linens, comforters, and bath towels were stocked during the visit. LPA inspected the following rooms: #201, #211, #307, #303, #423, #400, #418, #516 and #514. Bathrooms were operational with water temperature measuring between 105 - 120 degrees F.

LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately.

Continued LIC 809-C
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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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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: CITY VIEW LA, LLC
FACILITY NUMBER: 198603220
VISIT DATE: 09/19/2024
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Fire extinguishers were charged, and smoke detectors and carbon monoxide were operable in each resident's room. A review of the Medication Administration Records (MAR) was observed to be maintained in order and accurate. During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted.

LPA reviewed 7 resident files, and 7 staff files. The facility is current on Community Care Licensing (CCL) license annual dues.

An exit interview conducted and a copy of report and appeal rights was provided to Mendy Ginsberg.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC809 (FAS) - (06/04)
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