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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004456
Report Date: 06/23/2022
Date Signed: 06/24/2022 11:18:35 AM

Document Has Been Signed on 06/24/2022 11:18 AM - 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:VILLA LURENFACILITY NUMBER:
306004456
ADMINISTRATOR:BRIAN BUENVIAJEFACILITY TYPE:
735
ADDRESS:13749 E. CREWE STREETTELEPHONE:
(562) 941-3813
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY: 62CENSUS: 56DATE:
06/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:24 PM
MET WITH:Brian Buenviaje, AdministratorTIME COMPLETED:
05:05 PM
NARRATIVE
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Licensing Program Analyst (LPA) Galarza conducted an unannounced Required-1 year visit focusing on COVID-19 Infection Control Practices. LPA met with Administrator Brian Buenviaje and explained the purpose of the visit. There are 56 ambulatory mentally disabled clients ages 59 and under, of which 6 may be non-ambulatory. Facility is composed of 2 single-story buildings and one (1) two-story building, with a total of 30 resident rooms with shared bathrooms, dining hall, medication room, kitchen, laundry room, TV area, 2 offices, and outdoor covered patio areas. The kitchen and dining room are located in the middle of the property in a separate building. The facility is equipped with a sprinkler system. The last fire inspection was conducted on 10/3/2021 by LA County Fire Department. The last fire drill was completed on 4/27/2022. Administrator certificate expired on 10/3/2021.

The following were observed/inspected:
  • COVID-19 Infection Control Practices were not observed upon entry and in common areas.
  • Infection control signs, and other signs were not posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing. LPA was not screened upon entry. The facility has not resumed communal dining services, and there has not been any COVID-19 cases since Winter 2020.
  • Facility has designated COVID-19 isolation rooms if needed. PPE's were observed.
  • 17 client rooms, bathrooms, kitchen, and outdoor physical plant was inspected. Client beds in rooms 23 & 27 did not have mattress pad. Six (6) kitchen stove burners had inoperable ignition starters, rooms 23 and 29 beds did not have mattress pads, rooms 32 and 37 roof needs plaster, Rm 42 needs baseboard in bathroom, Rm 44 bathtub faucet handles need repair, Rm 32 had clogged toilet, and Rm 26 had bathroom water leaking into bedroom, the exterior physical plant behind the kitchen had discarded items i.e. over 40 shopping carts, and other discarded debris, and LPA observed 5 cockroaches near the sharps drawer and kitchen floor.

-See LIC 809C for report continuation-
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 3 of 13
Document Has Been Signed on 06/24/2022 11:18 AM - It Cannot Be Edited


Created By: Noemi Galarza On 06/23/2022 at 03:26 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: VILLA LUREN
FACILITY NUMBER: 306004456

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1550(c)
Suspension and Revocation
(c) Conduct which is inimical to the health, morals, welfare, or safety of either the people of this state or an individual in, or receiving services from, the facility or certified family home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that the facility does not have required infection control/social distancing postings at the main entrance or throughout the facility, COVID-19/Infection control screening is not being performed by staff, and no sign-in sheet or screening of visitors is in place; which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/24/2022
Plan of Correction
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Administrator shall put in place infection control postings at main entrance and throughout the facility. A visitor screening station shall be placed at the front lobby entrance, and all staff shall be trained in visitor screening protocols.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Hicks
LICENSING EVALUATOR NAME:Noemi Galarza
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/24/2022 11:18 AM - It Cannot Be Edited


Created By: Noemi Galarza On 06/23/2022 at 03:26 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: VILLA LUREN
FACILITY NUMBER: 306004456

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80072(a)(2)
Personal Rights
(a) Each client shall have personal rights including: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that the facility has not resumed communal dining services and there has not been any COVID-19 cases since Winter 2020, and residents are still eating in their rooms or outdoors; which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/25/2022
Plan of Correction
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Administrator shall open the dining room for communal dining for residents in care. Submit picture proof evidence by POC due date.
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, rooms 32 and 37 roof needs plaster, Rm 42 needs baseboard in bathroom, Rm 44 bathtub faucet handles need repair, Rm 32 had clogged toilet, and Rm 26 had bathroom water leaking into bedroom. Six (6) of the Kitchen stove igniters were not operable; staff were observed using a handheld igniter to turn the stove burners on. The exterior physical plant behind the kitchen had discarded items i.e. over 40 shopping carts, and other discarded debris; which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/25/2022
Plan of Correction
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Administrator agrees to repair and/or discard all items listed above. Submit a written statement and picture proof evidence of corrections.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Hicks
LICENSING EVALUATOR NAME:Noemi Galarza
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/24/2022 11:18 AM - It Cannot Be Edited


Created By: Noemi Galarza On 06/23/2022 at 03:26 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: VILLA LUREN
FACILITY NUMBER: 306004456

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)(1)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (1) The licensee shall take measures to keep the facility free of flies and other insects.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that during kitchen inspection LPA observed 5 cockroaches near the sharps drawer and kitchen floor; which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/25/2022
Plan of Correction
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Administrator shall submit proof that pest control services treated the kitchen and all other areas identified by pest control company. Licensee shall contract long term pest control services and follow assessment recommendations. Submit pest control invoice, copy of the contract, and a written statement that explains in detail the plan of correction.
Type B
Section Cited
CCR
85088(c)(4)
Fixtures, Furniture, Equipment, and Supplies
(c) The licensee shall ensure provision to each client of the following furniture, equipment and supplies necessary for personal care and maintenance of personal hygiene. (4) Clean linen in good repair, including lightweight, warm blankets and bedspreads; top and bottom bed sheets; pillow cases; mattress pads; rubber or plastic sheeting, when necessary; and bath towels, hand towels and wash cloths.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that LPA observed that rooms 23 and 29 beds did not have mattress pads. The mattresses were wrapped with plastic [not mattress protector]; which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/25/2022
Plan of Correction
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Administrator shall conduct staff training, complete a room/bed check of all facility resident rooms to determine if they need mattress pads, and mattress pads shall be placed in all resident beds. Submit a written statement stating how this was corrected, as well as picture proof.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Hicks
LICENSING EVALUATOR NAME:Noemi Galarza
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2022


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Document Has Been Signed on 06/24/2022 11:18 AM - It Cannot Be Edited


Created By: Noemi Galarza On 06/23/2022 at 03:52 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: VILLA LUREN
FACILITY NUMBER: 306004456

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85064.3(d)
Administrator Recertification Requirements
To apply for recertification prior to the expiration date of the certificate, the certificate holder shall submit to the Department's Administrator Certification Section, post-marked on, or up to ninety (90) days before, the certificate expiration date:
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that the Administrator Certificate expired 10/3/2021, which poses/posed a potential health, safety or personal rights risk to persons in care. Administrator stated that he has not completed all required courses for recertification.
POC Due Date: 07/25/2022
Plan of Correction
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Administrator agreed to submit proof of completed courses, and that he submitted all requirements to the recertification unit.
NOTE: If an extension is needed Administrator shall notify LPA by the POC due date [7/25/22].
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Hicks
LICENSING EVALUATOR NAME:Noemi Galarza
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2022


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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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: VILLA LUREN
FACILITY NUMBER: 306004456
VISIT DATE: 06/23/2022
NARRATIVE
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  • Nine (9) centrally stored client medications were reviewed.
  • Staff responsible for direct care and supervision were observed wearing masks.
  • Clients were not observed wearing masks. NOTE: DPH mask mandate allow persons to be without masks if they are fully vaccinated. Hand sanitizer and masks are distributed to clients in care upon request.
  • Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed.
  • A posted Emergency Disaster Plan was observed.

Deficiencies were cited per Title 22 and Health and Safety Code.

Exit interview was conducted with Administrator Brian Buenviaje. A copy of the report and appeal rights were issued.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
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