197607475-1-10-2024-11-AS-WGIS-CZD2FH-20240110162134

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607475
Report Date: 01/10/2024
Date Signed: 01/10/2024 04:21:39 PM

Document Has Been Signed on 01/10/2024 04:21 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	FINEST LIVING GUEST HOME		FACILITY NUMBER:	197607475
ADMINISTRATOR:	MARGARITA N. DAYAO		FACILITY TYPE:	740
ADDRESS:	20601 MANSEL AVENUE		TELEPHONE:	(310) 542-9639
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90503
CAPACITY: 6		CENSUS: 5	DATE:	01/10/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:41 PM
MET WITH:	Teresa Guanlao		TIME COMPLETED:	04:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 01/10/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced annual visit using the full CAREs tool. LPA met with Administrator, Teresa Guanlao, and explained the purpose of today’s visit. The facility is licensed for three (3) non-ambulatory and three (3) bedridden residents aged 60 and over. The facility has a hospice waiver for 5 residents. During time of visit the facility had 5 residents. Physical Plant/Structure The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) bedrooms of which one (1) is a private room and three (3) are shared rooms, 2 bathrooms, a living area, dining area, kitchen, and outside shaded patio area with table and chairs. LPA and administrator toured the inside and outside of the physical plant. There were no bodies of water or on the premises. All walkways outside of the facility were observed clean, clear, and free of obstructions, debris, and hazards. Bedrooms LPA inspected all bedrooms and observed them to be clean and in good repair. LPA observed all bedrooms to have the required furniture including a bed(s), dresser(s), nightstand(s), and ample storage space for residents belonging. LPA observed all beds had the required linens including a mattress cover, fitted sheets, blankets, comforter, and pillows. LPA observed an ample supply of linens and blankets in good repair. All bedrooms were observed with ample lighting. Bathrooms LPA inspected all bathrooms and observed them to be within Title 22 regulations and were clean and operational. All safety handrails were secured. LPA observed showers to have non-skid mats and a shower chair. LPA observed an ample supply of hygiene products, incontinent products, and towels. The water temperature in the bathrooms measured 115.7-degrees and 106.3-degress Fahrenheit. Kitchen LPA inspected the facility kitchen and found it to be clean and sanitary. LPA observed all appliances to be operational and in good repair. LPA observed a 3- day supply of perishable foods and a 7-day supply of non-perishable foods, properly stored, and labeled. LPA observed all knives and sharps to be secured in a locked drawer in the kitchen. LPA observed all cleaning supplies secured in a locked cabinet under the kitchen sink. LPA observed an ample supply of cookware, dining ware, and cutleries in good repair. The water temperature in the kitchen measured 107.2-degree Fahrenheit.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: FINEST LIVING GUEST HOME	FACILITY NUMBER: 197607475
	VISIT DATE: 01/10/2024

NARRATIVE

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Common Rooms LPA observed the facility to be sanitary and appropriately furnished at the time of visit. A comfortable temperature of 76 degrees was maintained in the facility. LPA observed all rooms and hallways to have ample lighting. LPA observed all walkways and hallways to be clean, clear, and free of obstructions and hazards. LPA observed a fireplace that is screened and inaccessible to residents.
Medications LPA observed all Centrally Stored Medication secured in a locked cabinet in the living room and are inaccessible to residents. LPA reviewed the medications for three (3) residents and the Medication Administration Record (MAR) and found the medications to be consistent with documentation. LPA observed all medications to be in their original packaging.
Files & Interviews LPA reviewed the files for three (3) residents and found they contained the required documents. During interview with residents, they stated they were happy with the services and care they receive from the facility. LPA reviewed the Administrator and two (2) staff files and found they contained the required documents, training, and certification. During interviews with staff, all were able to answer questions regarding resident care, rights, procedure, and policy. LPA reviewed the staff training logs and observed they had the required trainings and hours met for 2023. LPA reviewed and received a copy of the facilities Liability insurance through Acord which is valid till 07/07/24. LPA observed all mandated signs posted throughout the facility.
Safety LPA observed the smoke and carbon monoxide detectors to be fully operational. An additional carbon monoxide detector was observed in the dining room. LPA observed a fully charged fire extinguisher, in the dining room, last serviced on 11/04/23. The last Safety Fire Inspection was conducted on 02/20/23, by the Torrance Fire Department. The facility sprinkler system was last serviced on 02/20/23. The last emergency drill was conducted on 01/04/24. LPA inspected the First Aid Kit and observed it to have the required items and a manual. The facility has a working landline telephone. LPA observed all emergency phone numbers and Emergency Disaster Plan posted in the dining room.
Infection Control LPA observed sanitizing stations throughout the facility. LPA observed all required infection control signs posted throughout the facility. LPA observed a 30-day supply of Personal Protective Equipment (PPE). LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents.

LPA did not observe or cite any deficiencies during todays visit.

An exit interview was conducted with Administrator, Teresa Guanlao, and a copy of this report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

LIC809 (FAS) - (06/04)

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