Facility Evaluation Report

Licensing Program Analysts (LPA) Tena Herrera conducted the required annual inspection. LPA met with Evangeline De Casa (Administrator) and explained the purpose for today’s visit. The facility is licensed to serve 16 ambulatory and 4 non-ambulatory residents ages 60 and above. There is an approved hospice waiver for 1 resident.

- This is single-story facility located in Bellflower, Ca. A tour of the facility consists of 2 separate units and independent rooms with private bath along the back/outside. Main unit consists of kitchen, living room, dining areas, 4 resident bedrooms, 1 staff room/storage/medication room, 1 staff office. Leading to the exterior there are 6 private units with private baths. Detached garage and storage rooms/staff break room/backup refrigerator and freezer with food. Separate unit consists of 4 bedrooms and 2 bathrooms. There is a locked laundry area and linen storage near the separate unit. Facility has a large outside activity area, back yard, front yard and parking area in back yard. There is a fire sprinkler system throughout the facility.

LPA used the Compliance and Regulatory Enforcement (CARE) tools for the visit todays visit and observed the following:

Infection Control: The facility maintains the required Infection Control Plan.

Operational Requirements: The facility has an approved fire clearance and maintains valid liability insurance

Planned Activities: There is an outdoor activity area available for the residents. Administrator Stated that Staff #5 is the designated staff with the primary responsibility being to plan,prepare and conduct activities, however, after file review S5 does not have the proper training or education. LPA arrived to facility at 10:56am and left at 3:20pm, there were no observations of activities being conducted and S5 was not present at facility, citation being issued and detailed on LIC809-D page.

Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables.