198603365-9-19-2023-28-AS-LMOA-CVTT73-20230919142804

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603365
Report Date: 09/19/2023
Date Signed: 09/19/2023 02:28:08 PM

Document Has Been Signed on 09/19/2023 02:28 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	CASA DEL CORAZON ALEGRE, INC.		FACILITY NUMBER:	198603365
ADMINISTRATOR:	LOMEDA, RONA		FACILITY TYPE:	740
ADDRESS:	8515 RAVILLER DR.		TELEPHONE:	(562) 291-1451
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90240
CAPACITY:	6	CENSUS: 6	DATE:	09/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:38 AM
MET WITH:	Rona Lomeda- Administrator		TIME COMPLETED:	02:43 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) Luis Mora conducted an unannounced annual visit at the facility using the Care Tool. LPA Mora met with Rona Lomeda (Administrator) and explained the reason for the visit. The facility is licensed to serve 6 non-ambulatory residents ages 60 and over, of which 6 may be bedridden. Facility has a hospice waiver for 6 residents. The facility is operating within the scope of its license. A tour of the single-story facility included: 5 resident bedrooms, 1 resident bathroom, 1 staff/visitor restroom, living room, kitchen, dining area, nurse station, laundry room, front yard, backyard, and de-attached garage. LPA and Rona toured the facility, and the following was observed: sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. Auditory devices were seen on all exit doors which are required for dementia residents and were operating at the time of the visit. The water temperature was tested in the resident bathroom and measured at 105.2 degrees F which is within the required 105 - 120 degrees F. The bathroom is clean and have the required grab bars in the shower and near the toilet for non-ambulatory residents. The shower has non-skid materials. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Resident beds have the required linen and the linen is in good condition. There is extra clean linen and towels in the laundry room. The living room has a fireplace with a glass cover, making it inaccessible to residents in care. Smoke detectors were observed in each room and throughout the facility and are properly operating. Two carbon monoxide combined with smoke detectors were observed in the hallway and dining area and are properly operating. Fire extinguisher was observed in the living room which is fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps and cleaning supplies are kept locked under the kitchen sink. First Aid kit was fully stocked with current manual and it is kept in the medication cabinet. The front and backyard are well maintained. There is a shaded seating area for the residents located in the backyard. There are no bodies of water at the facility. Passageways and exits are free of obstruction. (Continued to LIC 809-C)

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CASA DEL CORAZON ALEGRE, INC.	FACILITY NUMBER: 198603365
	VISIT DATE: 09/19/2023

NARRATIVE

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Residents medication are centrally stored in a locked laundry cabinet. Residents and staff files are centrally stored in the nurse station. LPA reviewed medication for 6 residents and observed that medications are documented properly and given as prescribed. LPA reviewed files for all 6 residents and 4 staff. No deficiencies were observed with the files. LPA observed administrator certificate for Rona Lomeda – 6051556740 with an expiration date of 10/06/2023. LPA interviewed 2 staff and 2 residents.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there was no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC809 (FAS) - (06/04)

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