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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320280
Report Date: 10/06/2022
Date Signed: 10/06/2022 03:46:29 PM

Document Has Been Signed on 10/06/2022 03:46 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:TORRANCE REGENCY SENIOR LIVING IIFACILITY NUMBER:
198320280
ADMINISTRATOR:TAPORCO, ROBIN S.FACILITY TYPE:
740
ADDRESS:22549 S. VAN DEENE AVE.TELEPHONE:
(408) 916-7347
CITY:TORRANCESTATE: CAZIP CODE:
90502
CAPACITY: 6CENSUS: 6DATE:
10/06/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:27 PM
MET WITH:Jerrisa Bucu & Robin Tamporco TIME COMPLETED:
04:00 PM
NARRATIVE
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On 10/06/22, Licensing Program Analysts (LPAs) Ernand Dabuet and Mario Leon conducted an unannounced Case Management visit at this facility. Upon arrival, LPAs conducted a risk assessment. LPAs spoke with caregiver Joel Carbonell who confirmed the facility has no COVID activity. Carbonell contacted administrator Robin Tamporco by phone who late joined the team on this visit. LPAs explained the purpose of the visit is to conduct a health and safety inspection.

In this inspection, LPAs noted disinfectants and cleaning solutions under kitchen sink cabinets #1 and #2 unlocked and the washbasin in restroom #1 cabinet with cleaning solution chemical accessible to residents in care.

Based on observation, the licensee violated the California Code Regulations (CCR) of Title 22, Division 6, Chapter 8,

Deficiencies are issued and an exit interview is conducted with Jerrisa Bucu. A copy of this report is provided along with the appeal rights.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2022
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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Document Has Been Signed on 10/06/2022 03:46 PM - It Cannot Be Edited


Created By: Ernand Dabuet On 10/06/2022 at 02:38 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: TORRANCE REGENCY SENIOR LIVING II
FACILITY NUMBER: 198320280

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/07/2022
Section Cited
CCR
87705(f)(2)

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87705 Care of Persons with Dementia
(f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants.
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The licensee will adhere to Title 22 Section 87705. The licensee will perform knowledge of and conform to applicable laws, rules, and regulations. Plan of correction will be submitted by POC due date: 10/07/22 with confirmation of all hazardous materials are in locked storages units.
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This requirement was not met as evidenced by:
Based on observation, the licensee did not ensure hazardous materials were kept in locked storage units. This citation poses a immediate health and safety risk to residents in care.
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*This citation was corrected during visit.*

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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:Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:
DATE: 10/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2022


LIC809 (FAS) - (06/04)
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