306003060-5-28-2024-22-AS-EKIM-D5PVY9-20240528165047

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306003060
Report Date: 05/28/2024
Date Signed: 05/28/2024 04:51:43 PM

Document Has Been Signed on 05/28/2024 04:51 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	WEST GLENN MANOR		FACILITY NUMBER:	306003060
ADMINISTRATOR:	ROSARIO NAZARENO		FACILITY TYPE:	740
ADDRESS:	7242 WESTMINSTER BLVD.		TELEPHONE:	(714) 898-2131
CITY:	WESTMINSTER	STATE: CA	ZIP CODE:	92683
CAPACITY:	98	CENSUS: 85	DATE:	05/28/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Brian Nazareno and Rosario Nazareno		TIME COMPLETED:	05:00 PM

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On May 28, 2024 around 1:30PM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Administrator (AD) Brian Nazareno and explained the purpose of the visit.

The facility is licensed to operate for fifty (50) non-ambulatory and have a hospice waiver for three (3) residents. The facility is a single-story structure. It consists of the following: forty-eight (48) resident bedrooms, two (2) office rooms, twenty-six (26) bathrooms, living room, dining room, kitchen, and two (2) outdoor covered patio areas.

LPA Kim toured indoor and outdoor of the physical plant with AD Nazareno. AD Rosario Nazareno arrived around 2:20pm to join in middle of the physical indoor and outdoor tour. There are no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each client’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit . The following bedrooms were inspected: Resident Room 1, Resident Room 2, Resident 8, Resident Room 11, Resident Room 14, Resident Room 27, Resident Room 33, Resident Room 39, Resident Room 43 and Resident Room 46. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 106.3 degrees F and 114.0 degrees F. A comfortable temperature of 72 degrees F was maintained in the facility.

LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly.

Evaluation Report Continues on LIC 809-C

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (916) 956-7332
LICENSING EVALUATOR NAME: Edward Kim	TELEPHONE: (714) 293-1237
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024

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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: WEST GLENN MANOR	FACILITY NUMBER: 306003060
	VISIT DATE: 05/28/2024

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During the visit, LPA Kim observed the facility's infection control practices. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA Kim reviewed the facility’s plan of operation, emergency and disaster plan, and fire/safety drill log. The facility conducted a Fire/Safety Drill on February 24, 2024. A working telephone (714-898-2131) remains available. The facility has eight (8) fire extinguishers that are charged and they were all serviced on March 7, 2024, smoke detectors, and carbon monoxide detectors were operable. Emergency food, emergency water, and emergency supplies were stored in the storage room near resident room 1. Additional emergency water were stored in an outdoor storage unit.

Due to time constraints the following will be addressed on the continuation inspection on a later date: an audit of nine (9) resident files, nine (9) staff files, medication review, nine (9) resident interviews, staff interviews, and a first aid kit check.

No deficiencies were cited during this inspection visit.

An exit interview was conducted, and a copy of this report was provided to Administrator Rosario Nazareno.

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (916) 956-7332
LICENSING EVALUATOR NAME: Edward Kim	TELEPHONE: (714) 293-1237
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024

LIC809 (FAS) - (06/04)

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