300600816-7-6-2022-22-AS-JHAY-CG3SFV-20220706135058

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300600816
Report Date: 07/06/2022
Date Signed: 07/06/2022 01:51:09 PM

Document Has Been Signed on 07/06/2022 01:51 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	ROWNTREE GARDENS		FACILITY NUMBER:	300600816
ADMINISTRATOR:	CLAUDIA LUSCA-BORCSA		FACILITY TYPE:	741
ADDRESS:	12151 DALE STREET		TELEPHONE:	(714) 530-9100
CITY:	STANTON	STATE: CA	ZIP CODE:	90680
CAPACITY:	280	CENSUS: 200	DATE:	07/06/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:47 AM
MET WITH:	Claudia Lusca-Borcsa		TIME COMPLETED:	02:00 PM

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Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one year infection control annual visit. LPA was greeted, granted entry by staff and explained the reason for the visit. LPA Haley's temperature was checked and recorded upon entering the facility. Administrator (AD) Claudia Lusca-Borcsa was called and arrived at the reception desk, and was present during the tour of the facility.

At 12:11 PM LPA Haley and AD Claudia began the tour of the facility, at that time there were 200 residents present. A screening station was observed at the entrance of the facility equipped with a hands free temperature thermometer, hand sanitizer, and an iPad to fill out the screening questionnaire.

The inspection began by checking random resident rooms and recording hot water temperatures. All resident rooms that were inspected were clean, well organized, and had all the necessary requirements: night stand, chair, lamps/lights and storage space. Bathroom water temperatures were recorded in the range of 118.7 - 120 degrees Fahrenheit. LPA Haley advised AD Claudia the importance of monitoring the hot water temperatures and making sure the hot water temperature does not exceed 120 degrees Fahrenheit. LPA Haley observed a supply room well stocked with plenty of PPE.

The kitchen was clean and well organized. LPA Haley observed temperature logs on all the refrigerators, and a temperature log book for all the cooked food. The facility has a two day supply of perishable food items and seven day supply of nonperishable food items. All canned food noted to be within expiration date.

LPA Haley and AD Claudia inspect random rooms in the memory care unit. All rooms were clean, well organized, and furnished with the necessary items. At 12:45 the alert system in room A21 was tested and was operational.

CONTINUED ON LIC 809C DATED 7/6/22.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022

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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ROWNTREE GARDENS	FACILITY NUMBER: 300600816
	VISIT DATE: 07/06/2022

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During the inspection LPA Haley observed the required postings on the walls throughout the facility, as well as multiple screening stations throughout the facility.

The exterior portion of the facility was clean, and well organized. LPA Haley observed plenty of shaded areas with tables and chairs. Walkways were clean, clear, and free of debris and tripping hazards. No bodies of water were observed.

The facility conducts monthly emergency drills. The last fire drill was conducted June 5th, 2022.

No deficiencies are being cited during todays visit. An exit interview was conducted and a copy of the report was provided to Administrator Claudia Lusca-Borcsa.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2022

LIC809 (FAS) - (06/04)

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