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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603591
Report Date: 09/29/2022
Date Signed: 10/06/2022 03:04:31 PM

Document Has Been Signed on 10/06/2022 03:04 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:TOUCH OF AN ANGELFACILITY NUMBER:
198603591
ADMINISTRATOR:THOMAS, STACEYFACILITY TYPE:
740
ADDRESS:836 E 74TH STREETTELEPHONE:
(323) 879-5408
CITY:LOS ANGELESSTATE: CAZIP CODE:
90001
CAPACITY: 6CENSUS: 0DATE:
09/29/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Stacey ThomasTIME COMPLETED:
02:45 PM
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Licensing Program Analysts (LPAs) YaTing Yang and Joe Katrdzhyan conducted an announced pre-licensing visit. LPAs met with Administrator / Stacey Thomas and the property owner/ Jewel Reese for the purpose of conducting a pre-licensing inspection. Licensee /TOUCH OF AN ANGEL LLC. has submitted a license application to operate a Residential Care Facility for the Elderly for a capacity of six (6) residents, ages 60 and over. The facility has a fire clearance approved for five (5) non-ambulatory residents and one (1) bedridden in room #2. Licensee is subjected to terms and condition for hospice waiver approved for two (2) hospice residents. Fire clearance was granted on 8/25/22. The new application is being processed as an initial license. There are currently zero (0) residents living at the facility. TOUCH OF AN ANGEL submitted Advertising Dementia Special Care Program with application.

LPAs toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The facility consists of a main floor. A tour of the main floor includes a living room, kitchen, dining area, four (4) resident rooms, one (1) common bathroom, and one private bathroom located in bedroom #4, medication area, laundry area, multiple storage cabinets, and indoor/outdoor activity areas. There are three other property addresses located on the same premise, which include #834, #838, and #840, and they share the common yard areas. The Administrator ensures that the residents will not have non-supervised contact with tenants of the other properties.


LPAs observed one the fire extinguisher fully charged and in compliance. The facility is equipped with a centralized heating system and individual AC units inside resident room. Medications and First Aid Kit will be centrally stored and locked in the medication cabinets, located in the common bathroom.

Continue on LIC 809-C

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: YaTing Yang
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2022
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: TOUCH OF AN ANGEL
FACILITY NUMBER: 198603591
VISIT DATE: 09/29/2022
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LPAs observed a fully equipped living room and a dining room with sufficient dining capacity. Resident bedrooms were inspected for linens and personal accommodations for safety, privacy, and comfort. Resident bedrooms were equipped with a bed, chair, night stand, adequate lighting and ample closet/storage space for each resident. Bedroom #2 for bed-ridden resident has an exit door connected to outside. The exit doors are equipped with anti-wandering chimes. The bathrooms are clean and operational with non-skid mat. The kitchen was observed for the ability to prepare and serve food. Appliances in the kitchen were clean and all appeared functional. The supply of dishes/cups was adequate. During today's visit, LPAs observed the food supply of seven (7) days of non-perishables. The administrator ensures that she will purchase two (2) days of non-perishable foods upon licensure.

Resident and staff records will be centrally stored and locked in the cabinets located in the living room. Per Administrator, the facility will NOT be handling resident's P&I and other cash resources. All sharp objects and knives are stored in the kitchen cabinet making it inaccessible to residents. All toxins, cleaning solutions and supplies are locked underneath the kitchen sink, making it inaccessible to residents. No firearms will be kept at the facility. The facility smoke detectors and carbon monoxide detectors were tested and operational throughout the facility. There is a functioning telephone on the premises. The hot water temperature was measured throughout the facility between the range of 105 to 120 degree Fahrenheit and in compliance. There is no pool or other bodies of water during the visit.



The following concerns were observed during today's visit:
1. The front exit gate was NOT equipped a self-closing latch.
2. Drying machine was observed to be lack of a connecting tube, and therefore it is UNABLE to function.

Administrator understands that corrections are required for the above-mentioned items prior to licensure.
Component III was conducted during this visit.

LPAs used the inspection tool and the pre-licensing checklist for a Residential Care Facility for the Elderly during this visit.

An exit interview was conducted and a copy of the report was provided to the Administrator.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: YaTing Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022
LIC809 (FAS) - (06/04)
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