197607475-1-7-2025-11-AS-SLEO-DCPTPV-20250107135458

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607475
Report Date: 01/07/2025
Date Signed: 01/07/2025 01:55:16 PM

Document Has Been Signed on 01/07/2025 01:55 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/ DIRECTOR:	MARGARITA N. DAYAO		FACILITY TYPE:	740
ADDRESS:	20601 MANSEL AVENUE		TELEPHONE:	(310) 542-9639
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90503
CAPACITY: 6		CENSUS: 6	DATE:	01/07/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Administrator - Teresa Guanlao		TIME VISIT/ INSPECTION COMPLETED:	02:20 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 1/7/2024 around 9:30 AM, the California Department of Social Services (CDSS) – Community Care Licensing Division (CCLD) staff conducted an unannounced Required – 1 Year Inspection to the above-named facility and met with Administrator, Teresa Guanlao. CCLD staff explained the purpose of the visit and was accompanied by a staff member inside and outside the facility during this inspection. This facility is licensed to serve 6 adults ages 60 and above, of which 3 maybe non-ambulatory and 3 maybe bedridden. Approved for a hospice waiver for 5 residents. A total of 6 residents are currently residing in this facility. Facility Layout: The facility is a one-story house located in a residential street. The home consists of 4 resident bedrooms, 2 full bathrooms, 1 living room area, 1 kitchen area, 1 dining room area, 1 laundry area, 1 detached garage, and 1 backyard patio area with shaded seating.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

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 01/07/2025 01:55 PM - It Cannot Be Edited

Created By: Socorro Leandro On 01/07/2025 at 01:10 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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: FINEST LIVING GUEST HOME	FACILITY NUMBER: 197607475
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87309(a)

Storage Space and Access

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in having cleaning solutions accessible to residents in care (cleaning solutions were in both bathrooms in an unlocked storage area) which poses a potential health risk to persons in care.
	POC Due Date: 01/28/2025
	Plan of Correction
1 2 3 4	Staff moved cleaning solutions to a locked storage cabinet. The Administrator has agreed to retrain staff on how to properly store cleaning solutions. Administrator will email trainings to Socorro.Leandro@dss.ca.gov.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Ulysses Coronel

LICENSING EVALUATOR NAME:

Socorro Leandro

LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

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: 01/07/2025

NARRATIVE

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Outside Grounds: were toured no bodies of water were observed, walkways around the home were clear of hazards, and there are no security bars or weapons on the premises.

Kitchen Area/Facility Food: The facility has supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Knives and toxins were kept inaccessible to residents in care. There is fire extinguisher in the dining room are near the kitchen and it was last serviced on 4/9/2024. There is a landline telephone on the kitchen counter-top.

Living Room: There is a landline telephone, videoconferencing device, and games/activity work (i.e. board games) for residents in the living room area. There are couches and chairs for residents to sit at.

Resident Bedrooms: 4 out of 4 resident bedrooms were toured. There is adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition.

Bathrooms: Toilets, showers, and water faucets worked properly, grab bars were secure, and a non-skid mat was in place. Adequate lighting and toiletries accessible to residents. There were cleaning solutions accessible to residents in care.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

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: 01/07/2025

NARRATIVE

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Medications: were inaccessible to residents in care. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. 2 out of 6 Medication Administration Records (MARs) were reviewed and they were current and up to date.

Garage: was toured. The garage has several facility supplies.

Miscellaneous: Documents are posted as mandated. Last fire drill was completed on 1/5/2025. The last Annual Fire Inspection was completed on 4/5/2024 by the City of Torrance Fire Department. First aid kit is fully stocked with manual. Smoke and carbon monoxide detectors were in compliance and operational.

5 staff records were reviewed, 5 out of 5 staff records had required documentation.
5 resident records were reviewed and, 5 out of 5 resident records had required documentation. 3 out 5 residents Appraisal & Needs Service Plan did not have responsible party signature.

Change of Administrator was discussed with the Administrator.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

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: 01/07/2025

NARRATIVE

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A technical violation is being provided regarding resident records.

A deficiency is being cited based observation in accordance with the California Code of Regulations, Title 22. A deficiency regarding cleaning solutions accessible to residents in care.

An exit interview was conducted, Plans of Corrections were reviewed and developed. A copy of this report and appeal rights were discussed and left with the Administrator.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

LIC809 (FAS) - (06/04)

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