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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603222
Report Date: 12/22/2023
Date Signed: 12/28/2023 10:50:53 AM


Document Has Been Signed on 12/28/2023 10:50 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:WHITTIER PLACE SENIOR LIVINGFACILITY NUMBER:
198603222
ADMINISTRATOR:CASTILLO,JOSHUAFACILITY TYPE:
740
ADDRESS:12315 BURGESS AVENUETELEPHONE:
(562) 777-1477
CITY:WHITTIERSTATE: CAZIP CODE:
90604
CAPACITY:125CENSUS: 63DATE:
12/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Joshua Castillo TIME COMPLETED:
03:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced annual visit using the Infection Control Evaluation Tool. LPA met with Executive Director Joshua Castillo and explained the reason for the visit. Physical Plant was toured, medications were reviewed, resident and staff files were reviewed, and food supply was inspected.

LPA and Mr. Castillo toured the facility including common areas and a random sample of resident rooms. There are multiple shaded seating areas for the residents throughout the facility patio area. Passageways and exits are free of obstruction. The water temperature was tested in a random selection of resident bedrooms and measured between 116 degrees F - 120 degrees F which is within the required 105 F - 120 F degrees. Grab bars and non-skid mats were observed in resident bathrooms. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have sufficient closet space. Resident beds have the required linen and the linen is in good condition. Smoke detectors and carbon monoxide detectors were observed in resident rooms and were tested and operable during the visit. Facility common areas have a smoke alarm that is hard wired, tested and operational during the visit.

There are multiple fire extinguishers located throughout the facility. Kitchen appliances are clean and were operating at the time of the visit. Sharps are locked and are inaccessible to residents. Cleaning supplies and disinfectants are locked and are inaccessible to the residents.
  • Sufficient supply of 2 days perishable & 7 days non-perishable foods were observed.
  • 6 resident medications were reviewed at random. Medications are centrally stored in carts in the medication room. Medications are given as prescribed.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were deficiencies observed during the visit. Exit interview held and a copy of the report, and appeal rights were provided.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica ReaTELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:
DATE: 12/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2023
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 12/28/2023 10:50 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754


FACILITY NAME: WHITTIER PLACE SENIOR LIVING
FACILITY NUMBER: 198603222

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87411(c)(1)


This requirement is not met as evidenced by: LPA observed that staff #1-staff #4 did not have first aid cards in their files.
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 4 out of 4 staff files reviewed, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/12/2024
Plan of Correction
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Administrator will comply with Title 22 regulations, and will ensure that all staff have current first aid cards in their employee file, and will send proof to LPA by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica ReaTELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:
DATE: 12/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2023
LIC809 (FAS) - (06/04)
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