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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004456
Report Date: 04/19/2024
Date Signed: 04/21/2024 06:13:38 PM

Document Has Been Signed on 04/21/2024 06:13 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:VILLA LURENFACILITY NUMBER:
306004456
ADMINISTRATOR/
DIRECTOR:		BRIAN BUENVIAJEFACILITY TYPE:
735
ADDRESS:13749 E. CREWE STREETTELEPHONE:
(562) 941-3813
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY: 62CENSUS: 62DATE:
04/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Gloria GibsonTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced required annual visit. LPA met with Assistant Administrator Gloria Gibson and explained the purpose of the visit. Villa Luren is licensed to serve 62 mentally disabled adults, 6 may be non-ambulatory. The facility is single story & consists of 3 wings LPA toured all 3 wings with Ms. Gibson and observed the following:

Resident rooms, bathrooms, dining hall/TV area, medication room, kitchen, laundry room, 2 offices, and outdoor covered patio areas. The facility is equipped with a sprinkler system. The last fire drill was completed on 3/28/2024.

As a part of the inspection, LPA reviewed a (6) client records, (4) staff files, and (6) client medications. LPA toured facility and observed that toxins and sharps locked and inaccessible to clients. Bedrooms are equipped with a (2) beds each, a dresser, lamp, chair, overhead lightning for each client. The facility bedrooms have bathrooms which have a working toilet, wash basin, and bath/shower. Beds have the required linen/supplies which include, pillowcase, mattress padding, fitted sheet, blanket and bedspreads. Supply of hygiene supplies were observed. Facility has sufficient amount of perishable and non perishable food. Fire alarms are interconnected and operational. Smoke detectors and carbon monoxide detector tested and operational. Water temperature within required title 22 regulations, measured at 108 degree F.


Deficiencies cited on 809-D. An exit interview was conducted and a copy of this report, and appeal rights provided to Ms. Gibson.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Angelica Rea
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2024
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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Document Has Been Signed on 04/21/2024 06:13 PM - It Cannot Be Edited


Created By: Angelica Rea On 04/19/2024 at 03:14 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: 04/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80075(f)
(f) Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 3 out of 3 staff files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/26/2024
Plan of Correction
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Licensee will obtain a current First Aid/CPR certificate for Staff #1 - Staff #3 and submit a copy of the certificate to LPA Rea by POC due date.
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:Angelica Rea
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2024


LIC809 (FAS) - (06/04)
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