197607718-5-20-2024-11-AS-PBUR-D5FLDQ-20240520084020

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607718
Report Date: 05/16/2024
Date Signed: 05/20/2024 08:41:24 AM

Document Has Been Signed on 05/20/2024 08:41 AM - 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:	CENTINELA ASSISTED LIVING CENTRE		FACILITY NUMBER:	197607718
ADMINISTRATOR/ DIRECTOR:	GWENDOLYN CRAIG		FACILITY TYPE:	740
ADDRESS:	1000 S FLOWER ST		TELEPHONE:	(310) 674-3216
CITY:	INGLEWOOD	STATE: CA	ZIP CODE:	90301
CAPACITY: 96		CENSUS: 58	DATE:	05/16/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:55 AM
MET WITH:	Gwen Craig		TIME VISIT/ INSPECTION COMPLETED:	04:00 PM

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced required 1- year visit with the primary focus on Infection Control measures and using the new CARE Inspection Tool. Upon arrival at the facility, LPA Bunker conducted a risk assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA was properly screened for COVID-19 symptoms and temperature was checked. LPA Bunker met with Administrator Gwen Craig and explained the purpose of today's Annual Inspection. LPA Bunker verified that the facility has an approved mitigation plan report and infection control plan. The facility's annual fees are current.

12 Domains in the Infection Control Practices will be observed and reviewed. "I will be using this tool and methods that have been developed to improve the efficiency and accuracy of the Department of Social Services' facility inspections."

The above facility is a single-story business building located in a residential neighborhood. LPA Bunker and Administrator Gwen Craig toured the facility's main office/receptionist area, administrator office, medication room, nurse station, dining room, break room, kitchen, male and female's restrooms, public restrooms, activity room, hair salon, janitor closet, storage closet, laundry room located on the other side of the parking lot, patios, shaded area, and indoor/outdoor activity areas. During the visit bedrooms and bathrooms #7, #9, #15, #16, #30, #31, #38, #39, #43, #44, #53, #54, and #59 were observed.

See continued LIC809-C page

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

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: CENTINELA ASSISTED LIVING CENTRE	FACILITY NUMBER: 197607718
	VISIT DATE: 05/16/2024

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Continued LIC809-C page 2

Documents have been diligently posted as mandated on the wall in the receptionist area, nurse station, dining room, break room, and hallway. The following Title 22 regulated areas were audited and found to be in compliance: Bedrooms contain the required furniture, and bathrooms are clean and operational. Personal accommodations were observed for safety, privacy, and comfort, including the provision of non-skid surface mats. The kitchen was observed for its ability to prepare and serve food. The food service was reviewed for appropriate quantity and proper storage; there was an ample supply of perishable and nonperishable food. The resident’s medications were reviewed for proper storage, documentation, and system implementation. Medications are securely locked in the medication room, records are current and up to date. Common areas observed for the ability to safely serve the needs of the residents, including cleanliness, and clear of any potential hazards to the residents. The first aid kit is fully stocked with manual, smoke, and carbon monoxide detectors were in compliance, the hot water temperature was measured within normal limits at 120 degrees Fahrenheit (within the range of 105-120 degrees Fahrenheit). The fire extinguishers are fully charged, adequate linen supply, and the facility's telephones are tested and found to be in working order, The resident's bedroom windows have no sliding window lock with thumbscrews, all exit doors were found to be in compliance, the yard was free of debris hazards, and trash cans were covered. Staff members have undergone training on reporting dependent adult and elder abuse. The facility conducted a fire drill on May 14, 2024.

Due to time constraints and technical difficulties, LPA Bunker will return at a later date to conclude the visit.

There were no deficiencies cited.

Exit interview conducted.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

LIC809 (FAS) - (06/04)

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