197608279-10-25-2022-11-AS-ASOO-CKJNJV-20221025103058

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608279
Report Date: 10/22/2022
Date Signed: 10/25/2022 10:31:12 AM

Document Has Been Signed on 10/25/2022 10:31 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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	UTMOST LIVING CARE INC.		FACILITY NUMBER:	197608279
ADMINISTRATOR:	TERESA GUANLAO		FACILITY TYPE:	740
ADDRESS:	6750 ABBOTSWOOD		TELEPHONE:	(310) 525-4112
CITY:	RANCHO PALOS VERDES	STATE: CA	ZIP CODE:	90275
CAPACITY: 6		CENSUS: 6	DATE:	10/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Teresa Guanlao, Administrator		TIME COMPLETED:	12:00 PM

NARRATIVE

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Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual required and infection control visit to the above facility. LPA was met by Teresa Guanlao. Administrator and the purpose of today’s visit was explained.

There are currently (6) residents in the facility. (1) residents are ambulatory, (2) are non-ambulatory, (3) bedridden. The facility is a single-story structure located in a residential neighborhood. It consists (4) bedrooms, (2-1/2) full bathrooms, shaded back yard, front yard, laundry room and a detached 2 garage.

LPA and Alvin toured the entire facility inside and out. Documents are posted as mandated. Bedrooms 1-4 are occupied by residents and contain the mandated furniture. The (1-1/2) bathrooms have grab bars and non-skid mats and are clean and operational, 2nd Bathroom has 1 faucet not working (broken) and other faucet has left hot water handle broken, and toilet paper handle missing. First aid kit is fully stocked with manual; smoke detectors and carbon monoxide detector were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. (1) Resident file along with medications are current. (1) Staff file is current. Ample supply of perishable and nonperishable food, hot water temperature is (105) degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, (1) fire extinguisher is fully charged. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: UTMOST LIVING CARE INC.	FACILITY NUMBER: 197608279
	VISIT DATE: 10/22/2022

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During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry & visitors and temperatures are logged and checked, sanitizer/soap, paper towels, in all the bathrooms and additional sanitation supplies are stored in the garage. LPA observed staff wearing masks, resident private rooms will be converted to isolation rooms (if needed) needs trash cans with lids, needs cart for PPE’s, mitigation plan was not posted and/or in folder, Fit testing completed for staff, and required postings throughout the facility. Visitor designated area, facility has internet & Phones for residents to use, resident’s temperatures are checked and logged (once a day). Emergency contacts updated and posted; PPE's are enough for 30 days. All residents and staff are vaccinated and boosted.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA observed the following deficiency and issued a citation.

Technical Advisory (TA) issued.

1. Mitigation Plan must posted and/or binder.
2. Rolling cart for PPE's
3. Trash can with lid

An exit interview was conducted with Teresa Guanlao, Administrator and a hard copy of report was provide along with Appeal Rights provided

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/25/2022 10:31 AM - It Cannot Be Edited

Created By: Ana Soto On 10/22/2022 at 10:48 AM

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: UTMOST LIVING CARE INC.	FACILITY NUMBER: 197608279
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited


	Deficient Practice Statement
1 2 3 4	87303(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.This was not met as evidence by; Based on 2nd bathroom has one faucet handle broken and the other faucet not working at all. Toilet Paper holder is missing.Which poses a potential health and safety for all persons in care.
	POC Due Date: 11/20/2022
	Plan of Correction
1 2 3 4	Administrator repair faucets and send repair invoice and picture working faucet, to LPA by POC due date.

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:

Janae Hammond

LICENSING EVALUATOR NAME:

Ana Soto

LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2022

LIC809 (FAS) - (06/04)

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