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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607718
Report Date: 07/05/2022
Date Signed: 07/05/2022 04:59:34 PM

Document Has Been Signed on 07/05/2022 04:59 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME:CENTINELA ASSISTED LIVING CENTREFACILITY NUMBER:
197607718
ADMINISTRATOR:GWENDOLYN CRAIGFACILITY TYPE:
740
ADDRESS:1000 S FLOWER STTELEPHONE:
(310) 674-3216
CITY:INGLEWOODSTATE: CAZIP CODE:
90301
CAPACITY: 96CENSUS: 60DATE:
07/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:42 PM
MET WITH:Gwendolyn CraigTIME COMPLETED:
05:00 PM
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On 7/5/2022, Licensing Program Analyst (LPA’s) Stephanie Cifuentes and Antonia Alvizar conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA’s met with Medical Technician Victoria Calderon, explained the purpose of today’s visit and were allowed entrance to the facility. The facility is an RCFE licensed for (60) ambulatory and (36) non- ambulatory residents. Facility has no hospice waiver. LPA and staff were later joined by administrator Gwendolyn Craig.

The facility is a one-story structure located in a residential neighborhood. LPA’s Cifuentes, Alvizar and staff Victoria Calderon toured the physical plant.

During the visit, LPA observed the facility infection control practices. LPA observed screening protocol for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings, sign in and out logs for visitors and staff are present in the facility.

Due to time constraints, visit will be completed at a later date.

An exit interview was conducted, and a copy of this report was provided to Gwendolyn Craig, Administrator.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Stephanie Cifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 07/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/05/2022
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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