198603694-3-20-2024-28-AS-KRAZ-D3JSYE-20240320141726

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603694
Report Date: 03/20/2024
Date Signed: 03/20/2024 02:17:32 PM

Document Has Been Signed on 03/20/2024 02:17 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:	LEISURE LIVING HOMES, THE		FACILITY NUMBER:	198603694
ADMINISTRATOR:	HECHANOVA, MARJORIE		FACILITY TYPE:	740
ADDRESS:	1738 FINECROFT DRIVE		TELEPHONE:	(818) 400-4667
CITY:	CLAREMONT	STATE: CA	ZIP CODE:	91711
CAPACITY:	6	CENSUS: 4	DATE:	03/20/2024
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	12:46 PM
MET WITH:	Marjorie Hechanova		TIME COMPLETED:	02:30 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 Analysts (LPAs) Ramirez and Gutierrez made an announced visit and met with Licensee Majorie Hechanova to conduct a Pre-Licensing evaluation. An application was submitted to Community Care Licensing Department (CCLD) on for an initial application of a Residential Care Facilities for the Elderly (RCFE) to serve adults ages 60 and over. A Dementia waiver and a hospice waiver for six (6) is in place. The requested capacity is for five (5) non-ambulatory, of which one (1) may be bedridden. Bedroom#4 is approved for one (1) bedridden resident. Bedrooms #1,2,3, and 5 are approved for non-ambulatory. Structure: Facility is a single-story home located in a residential area consisting of five (5) bedrooms, three (3) bathrooms, kitchen, dining room, living room, laundry area in attached garage, backyard with outdoor covered patio, storage shed in the rear of the backyard. Front yard is landscaped with grass and back yard is landscaped with paved walkway. Bedroom Clients: Bedroom#1, 3, 4 and 5 are private. Bedroom#2 is shared. Bedrooms are equipped with one bed, nightstand, chair, lamp, and overhead lighting. Bathrooms: Two (2) full bathrooms equipped with working toilets, wash basins, bathtub/ walk-in shower. Bathroom#3 is located in staff office and is a half bathroom. Linens & Hygiene Supplies: All beds had the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linens is stored in linen closets. Emergency Phone Numbers, Exit Plan: Emergency numbers are posted and readily available for review. One (1) fully charged fire extinguisher was observed. Facility has a land line telephone. Food Service: Dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils were observed locked and inaccessible. Adequate food supply is stored in the kitchen and consists of the following: 2-day perishables, and 7-day non-perishables. Emergency water supply was observed. Smoke Detectors: There are electrical & inter-connected smoke detectors located in all bedrooms, common areas, and hallways. Appliances: Refrigerator, oven, microwave, dishwasher and washer/dryer are in good condition. The residence is equipped with central heating and air conditioning. Toxins: Cleaning supplies, and toxins are locked only accessible to staff. *Narrative continues next page.**

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly Ramirez	TELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: LEISURE LIVING HOMES, THE	FACILITY NUMBER: 198603694
	VISIT DATE: 03/20/2024

NARRATIVE

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Water Temperature: Hot water was tested in all bathrooms, and kitchen sink. Water temperature was within normal limits 105 degrees Fahrenheit (40.5 degrees C) and not more than 120 degrees Fahrenheit (48.8 degrees C). Medication, First-Aid Kit & Book: Designated centrally stored medications cabinet, and the first-aid kit has been inspected which has at least the following: tweezers, scissors, antiseptic, bandages, gauze, thermometer; including a current First Aid manual. Resident & Staff Files: Designated area for files will be in staff office. Pools/Jacuzzi/Body of Water & Pets: No bodies of water were observed. No health and safety concerns were observed. Fire Clearance: Fire clearance was approved on 2/29/24 for 5 non-ambulatory, and 1 bedridden in room#4. Component III: Component III was waived. Applicant is presently a Licensee of another other RCFE.

An exit interview was conducted and a copy of this report has been furnished to Majorie Hechanova. Accordingly, 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: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly Ramirez	TELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

LIC809 (FAS) - (06/04)

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