198603694-6-20-2024-28-AS-KRAZ-D6EVKB-20240620163004

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603694
Report Date: 06/20/2024
Date Signed: 06/20/2024 04:30:11 PM

Document Has Been Signed on 06/20/2024 04:30 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:	06/20/2024
TYPE OF VISIT:	Post Licensing	UNANNOUNCED	TIME BEGAN:	07:53 AM
MET WITH:	Administrator Marjorie Hechanova		TIME COMPLETED:	01:15 PM

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted unannounced post-licensing inspection. LPA met with Administrator Marjorie Hechanova and explained purpose of today’s visit. This facility is licensed to serve six (6) residents over the age of 60, of which, five (5) non-ambulatory of which one (1) may be bedridden. Bedrooms #1,2,3, and 5 are approved for non-ambulatory. Bedroom#4 is approved for one (1) bedridden resident. This facility may retain no more than six (6) hospice residents. There are four (4) residents under hospice care at this time.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Physical Plant and Environment safety: Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to residents, were observed to be inaccessible to residents. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected five (5) rooms. All resident bedrooms contained required furniture, linens and lighting. Water temperatures in all grooming and bathing areas were measured to be within 105 – 120 degrees F. LPA Ramirez observe postings encouraging proper hand washing etiquette in restrooms. LPA Ramirez observed grab bars near toilets and inside showers.

Food Service: LPA Ramirez observed sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40 degree F. (4 degree C).

Planned Activities: LPA Ramirez observed posted monthly and weekly activities poster in facility dining room area.

Residents Rights-Information: LPA Ramirez observed the following postings: Complaint Poster (PUB 475), personal rights, and nondiscrimination notice. LPA Ramirez observed facility land line to be operational.

SEE 809-C for contiued narrative report.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly Ramirez	TELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

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: 06/20/2024

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Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D) in place. Emergency drills were conducted quarterly. LPA Ramirez observed facility sketches with exits and emergency exits routes throughout various locations of the facility. LPA Ramirez observed emergency food supply.

Residents with Special Needs: No large bodies of water were observed. LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Ramirez observed several oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Auditory devices and delay egress perimeters were observed to be in working order.

Health Related Services/Incidental Medical Services: The medications are centrally stored in the medication cabinet and in bubble packs and/or original containers. The facility uses the Medication Administration Record (MAR) log to document medications given. The facility provides incidental medical services. LPA Ramirez compared four (4) residents’ medications to clients’ MAR.

Staffing: Administrator Certificate for Marjorie Hechanova (6057186740) expires on 09/17/2024. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility.

Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez observed required annual training, CPR and First Aid for three (3) out of the three (3) personnel records reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for three (3) out of the three (3) personnel records reviewed.

Infection Control: There are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place.

Operational Requirements: The fire clearance is approved for five (5) non-ambulatory, of which one (1) may be bedridden. This facility may retain no more than six (6) hospice residents. There are currently four (4) residents under hospice care.

Resident Records/Incident Reports: LPA reviewed resident files for four (4) residents. Resident files are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed.
No deficiencies were cited during post-licensing inspection. Exit interview conducted. A copy of this report was provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly Ramirez	TELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

LIC809 (FAS) - (06/04)

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