Facility Evaluation Report

Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Assistant Administrator Daniela Duarte and explained the purpose for today’s visit. The facility is licensed to serve (6) non-ambulatory individuals ages 60 and over (1) of which may be bedridden in Room #1. There is a hospice waiver for (2). The facility currently has (1) resident that is receiving hospice services.

This is a single-story home located in a residential area in Bellflower, Ca. A tour of the facility includes: living room, dining area, kitchen, 3 bedrooms, 1 1/2 bathrooms (1/2 bath is designated for staff), laundry area is in the outdoor patio, there is a front yard and back yard. There is a separate detached ADU in the back of the facility that is currently occupied by licensee, this ADU is not part of the licensed facility.

LPA utilized 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.

Residents Rights-Information: Residents are provided with telephone and internet at the facility. The facility has the following posters posted: Residents Rights, Complaint Poster, and Ombudsman.

Planned Activities: Facility provides scheduled activities and have a variety of activities to choose from within the facility. There is an outdoor activity area available for the residents.

Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers, however, Assistant Administrator Daniela confirmed they have not been conducting the required quarterly drills, details of this citation will be documented on the LIC809-D page.