300602548-6-16-2022-22-AS-SFRK-CFFW3P-20220616165615

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300602548
Report Date: 06/16/2022
Date Signed: 06/16/2022 04:57:03 PM

Document Has Been Signed on 06/16/2022 04:57 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:	KATELLA SENIOR LIVING COMMUNITY		FACILITY NUMBER:	300602548
ADMINISTRATOR:	LINDSAY SCHROEDER		FACILITY TYPE:	740
ADDRESS:	3952 KATELLA AVENUE		TELEPHONE:	(562) 596-2773
CITY:	LOS ALAMITOS	STATE: CA	ZIP CODE:	90720
CAPACITY:	140	CENSUS: 64	DATE:	06/16/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Executive Director Christine Greenway		TIME COMPLETED:	03:05 PM

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Licensing Program Analyst (LPA), Shobhana Frank , made an unannounced visit to the facility to conduct a required 1 Year Inspection. LPA Frank was granted entry into the facility by staff Charnesha Thomas. LPA Frank reviewed the facility file prior to the visit. LPA Frank toured the facility with Executive Director Christine Greenway. A tour of the facility was conducted inside and out of physical plant.
The following was observed

LPA observed COVID - visitation station equipped with hand sanitizer, thermometer, visitors log. LPA observed COVID posters throughout the facility.

This. Facility is Licensed for a capacity of 140 residents, ages sixty (60) and above. The facility is operating in the capacity and conditions approved by CCL There are six resident receiving hospice services. There is no pool or bodies of water accessible to residents in care.

LPA inspected a random selection of resident rooms and bathrooms, tested the call system, and met with residents and staff. Fire extinguishers were fully charged. The facility is equipped with a hard wired smoke detectors and is monitored by the local fire department quarterly. The last fire drill was conducted on 5/23/22. Auditory devices were tested on all exits. The facility appears to be operating within the terms and conditions of their license.

LPA observed 2-day supply of Non-perishable and 7-day supply of perishables food available in the kitchen and refrigerators. Facility refrigerator, frizzier and canned food were inspected. All canned food noted to be within expired date. LPA observed plenty of fresh fruits, vegetable and water available for residents. Meal menus were posted. LPA observed emergency food, water and PPE supply. Kitchen area was free of potential hazards and appeared to be meet sanitary regulations.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Shobhana Frank	TELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022

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: KATELLA SENIOR LIVING COMMUNITY	FACILITY NUMBER: 300602548
	VISIT DATE: 06/16/2022

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LPA verified if facility is providing a comfortable temperature due to hot/cold weather condition. Facility temperature measured at 75.8 F. Facility has a working heater to use for the cold weather and air condition/ fans for the hot weather. Activity supplies for the residents were observed in fire side lunge.
LPA Frank tested the hot water temperature in residents bathrooms which measured between 109.5 to 110.3 degrees F in resident bathroom. Resident areas were noted to be a comfortable temperature.

Administrator Certificate is current. Administrator on the premises every day to oversee the business operations and ensure quality care is being provided.

LPA reviewed most recent LIC 808 Mitigation Plan, LIC 500, Personnel Report, , LIC 610 Emergency LIC 308, Designation of Administrator Responsibility and , forms were completed as required.

Based on the observations made during this inspection there are no deficiencies being cited per Title 22, Division 6, of the California Code of Regulations.

LPA discussed this report with the representative. A copy of this report was provided.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Shobhana Frank	TELEPHONE: (714) 293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022

LIC809 (FAS) - (06/04)

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