198603504-11-23-2021-28-AS-NGAA-C932QL-20211123163605

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603504
Report Date: 11/23/2021
Date Signed: 11/23/2021 04:36:11 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:	LA POSADA		FACILITY NUMBER:	198603504
ADMINISTRATOR:	HILL, JANETTE		FACILITY TYPE:	740
ADDRESS:	8120 PAINTER AVE		TELEPHONE:	(562) 945-2651
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90602
CAPACITY:	114	CENSUS: 64	DATE:	11/23/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Janette Hill, Administrator		TIME COMPLETED:	04:45 PM

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Licensing Program Analyst (LPA) Galarza conducted an announced visit to the facility for the purpose of a Pre-licensing evaluation. LPA met with Licensee Michael Radnia and Administrator Janette Hill. Administrator provided assistance with the tour of the physical plant.

An application was submitted to CCLD on 7/9/2021 for a Change of Ownership for a Residential Care Facility for the Elderly for ages 60 years and older. The fire clearance has been approved for a capacity of 114 residents, which 99 may be non-ambulatory and 15 may be bedridden. A hospice waiver for 20 residents is in place.The facility has a Memory Care/Dementia unit of 26 residents. There are currently 64 residents residing at the facility and 9 are receiving hospice care.

Physical Plant:

Facility is a three (3) story building consisting of 77 resident rooms. The 1st floor consists of a lobby, dining room with outdoor courtyard, kitchen, medication room, administrative offices, electrical room, public restrooms, laundry room, 21 resident rooms, shaded outdoor courtyard area, and a Memory Care unit with multi-purpose room, and outdoor courtyard. The 2nd floor consists of 28 resident rooms, Bistro area, game room, public restrooms, 2 storage rooms, laundry/housekeeping room, outdoor shaded balcony area, and 2 common areas. The 3rd floor consists of 28 resident rooms, fitness room, theater room, lounge, beauty shop, and outdoor shaded balcony area. The passageways and walkaways are free from obstructions. The front and back areas are free of debris/hazards. There is a rear parking lot. There are no pools or bodies of water at the facility. Residents may have pets. An generator was observed.

Observations: There are evacuation chairs on 2nd and 3rd floor stairwells to be used during an emergency as a path of egress from the facility to safety were observed. The facility does not have surveillance video cameras in place. Rooms 108, 208, and 307 are undergoing repairs due to water damage sustained by plumbing issue. The remediation company was observed working/repairing the issue.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 11/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2021

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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: LA POSADA	FACILITY NUMBER: 198603504
	VISIT DATE: 11/23/2021

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Signal System: The signal system was tested and is operational.

Fire Inspection: The last fire inspection was conducted on 1/22/2021. The last fire drill was conducted on 9/15/2021.

Smoke Detectors: There are electrical & inter-connected smoke detectors located in all bedrooms, common areas, and hallways Battery operated carbon monoxide detectors were observed in hallways.

Appliances: Refrigerators, Stove burners, Oven, Freezers, Washer and Dryer are all working properly.

Bedrooms: There shall be no more than two clients per bedroom. Bedrooms are equipped with a bed, night-stand, overhead lighting, and closet space. Hand sanitizer and masks were observed in all resident rooms.

Staff bedrooms: No rooms are designated for live-in staff.

Bathrooms: All bathrooms have a working toilet, wash basin, and bathtub/shower. Each floor has public restrooms. Public restrooms have infection control postings in place

Linen and Hygiene Supplies: Beds have the required linen/supplies which include pillowcase, mattress pads, fitted sheet, blanket and bed spreads. Adequate supply of linens, hygiene supplies, and Personal Protective Equipment (PPEs) are in place.

Emergency Phone numbers, exit plan and menu: Posted and readily available for review in the hallway of first floor. All fire extinguishers are fully charged.

Toxins:
All are stored and locked in supply rooms, locked cabinets, and outdoor storage areas.

Water Temperature: The hot water temperature tested between 105-120 degrees Fahrenheit which meets Title 22 regulations.

First Aid Kit and Book: A first aid kit was inspected, which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze. Facility does not have a First Aid Manual.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 11/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2021

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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: LA POSADA	FACILITY NUMBER: 198603504
	VISIT DATE: 11/23/2021

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Food Service: Dishes and cups and flat ware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are stored in the kitchen and only accessible for staff. Food supply is stored in the kitchen and consists of following: 2 days perishable food and 7 days non-perishable food. The freezer was maintained at 0 degrees F and the refrigerator was at 40 degrees F. Food in refrigerators were properly covered to avoid contamination. Dishes, cups and flat ware are stored in the kitchen area.

Staff and Residents files: Staff and Residents files are stored and maintained at the facility. LPA randomly selected 7 residents and 8 staff files to ensure all required forms are in the files. Centrally Stored Medication and Destruction Records were reviewed. Applicant will handle cash resources of residents. A surety bond is not in place. Administrator certificate expires 7/13/2022.

Liability Insurance: One million dollars ($1,000,000) per occurrence and three million ($3,000,000) in the total annual dollars aggregate.

Fire clearance: Granted on 8/24/2021 for 99 non-ambulatory and 15 bedridden residents. Delayed egress is in place in the 1st floor Memory Care unit.

Component III: Component III was conducted.

The following items must be corrected, and proof of correction shall be submitted to the CCLD office to the attention of LPA Galarza by 12/21/2021. If additional time is required to complete noted items to correct, then the applicant will request an extension in writing prior to the due date. Some items may require a follow up inspection for verification of correction.

1. Copy of Surety Bond

2. First Aid Manual

3. Updated plan of operation to include cash handling/Surety Bond information

4. Correct facility sketch room names

An exit interview was conducted with Administrator Janette Hill. A copy of the report was issued. LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 11/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2021

LIC809 (FAS) - (06/04)

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