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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005440
Report Date: 06/06/2022
Date Signed: 06/06/2022 11:20:00 AM


Document Has Been Signed on 06/06/2022 11:20 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:CARE MARSTEL 1FACILITY NUMBER:
306005440
ADMINISTRATOR:MARTINEZ, MINELLIFACILITY TYPE:
740
ADDRESS:1050 KINGSTON DRIVETELEPHONE:
(562) 245-6669
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:6CENSUS: 4DATE:
06/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lorraine Macasalabang, Elvin David, Shirely Natividad TIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Edward Tapia made an unannounced required annual inspection at this facility. LPA met with staff Lorraine Mascasalabang and stated the purpose of this visit. Administrator Shirley Natividad arrived after the inspection.

The facility is a two level structure and licensed for six non-ambulatory of which three can be on hospice. This facility offers Residential Care for the Elderly.

At about 9:00 am, LPA Tapia was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. For this visit, LPA observed four clients in care and two staff members on duty. LPA toured the interior and exterior portions of the facility. There were three resident rooms one of which was a private resident room and two could be shared rooms. Resident rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Manual smoke detectors, carbon monoxide, and auditory exit alarms were tested to be operational. Bathroom (1) was observed to be in good repair and provided with grab bars and hot water was measured at 122.3 degrees Fahrenheit. Bathroom (2) was observed to be in good repair and provided with grab bars and hot water was measured at 110.3 degrees Fahrenheit. Administrator was made aware of water temperature. LPA toured the second floor of the facility and was made aware that it was only for staff. Facility met the minimum two day supply of perishable and seven day supply of non-perishable food stock requirements, cleaning supplies and sharp items were inaccessible to residents in care. Facility had adequate supplies of personal protective equipment in place. Fire extinguisher was observed to be charged and operational. For the exterior portion, facility had outside furniture in good repair; and grounds were free of tripping hazards. LPA observed a shovel outside and staff immediately removed and locked up equipment. The backyard also contained an operational washer/dryer.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Edward TapiaTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2022
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: CARE MARSTEL 1
FACILITY NUMBER: 306005440
VISIT DATE: 06/06/2022
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Facility also had a 2 car garage which is used for storage and emergency supplies. Kitchen was in good repair with knifes and cleaning supplies kept locked. LPA noticed some of the emergency food supplies were expired and informed Administrator. LPA Tapia reviewed the COVID 19 mitigation plan of the facility. LPA discussed Assembly Bill 665 that requires a licensee of any adult care residential facility that has internet service to provide at least one internet access device, such as a computer, smart phone, tablet or other device, that: can support real-time interactive applications; is equipped with video conferencing technology, including microphone and camera functions; and is dedicated for client or resident use.

For this visit, no deficiency was noted in areas observed. No citation was issued. Five advisories were issued today.

LPA Tapia conducted an exit interview with Administrator Shirley Natividad and copy of this report was explained and left at the facility.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Edward TapiaTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

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

DATE: 06/06/2022
LIC809 (FAS) - (06/04)
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