198320358-4-3-2023-11-AS-LMOA-CQJL6R-20230403082908

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320358
Report Date: 03/30/2023
Date Signed: 04/03/2023 08:29:21 AM

Document Has Been Signed on 04/03/2023 08:29 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	SWEET CARE MANOR		FACILITY NUMBER:	198320358
ADMINISTRATOR:	ALCANTARA, CHARMAINE		FACILITY TYPE:	740
ADDRESS:	2451 W 235TH STREET		TELEPHONE:	(310) 325-1879
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90501
CAPACITY: 6		CENSUS: 6	DATE:	03/30/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	CHARESA REYES		TIME COMPLETED:	03:45 PM

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On 3/30/2023, Licensing Program Analyst (LPA) Lourdes Montoya conducted an announced visit to this home. LPA met with Applicant Charesa Reyes who assisted with the visit. The purpose of the visit was explained.

An application was submitted to CCLD for a Change of Ownership for a Residential Care Facility for the Elderly. The applicant requested a capacity of six (6) individuals of which four (4) are non-ambulatory and two (2) are bedridden. There are currently six (6) residents and two (2) caregivers present during the visit.

Structure:
The facility is a one-story house located in a residential neighborhood and consists of four (4) resident bedrooms, two (2) bathrooms, two (2) car garage, living room, dining area, and kitchen. Bedroom #2 is designated and approved for a bedridden resident. The facility is clean and sanitary. Protective devices are in place to include non-slip material on rugs. Indoor and outdoor passageways, stairways, inclines, ramps, open porches, and other areas of potential hazard are free of obstructions. All window screens are clean and in good repair. The facility temperature is between 68 degrees and 85 degrees.

Bedrooms (Residents):

All resident bedrooms include (1) a bed, one (1) chair, one (1) nightstand, and one (1) table lamp. Client bedrooms are large enough to allow for easy passage and to accommodate furniture and assistive devices such as wheelchairs, walkers, or oxygen equipment. No client bedroom is a passageway to another room, bath, or toilet.

Bedrooms (Staff):

There is no staff bedroom.

Bathrooms:
The two bathrooms have a working toilet, washbasin, and shower with grab bars and non-skid mats.

Evaluation Report Continued in LIC809-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SWEET CARE MANOR	FACILITY NUMBER: 198320358
	VISIT DATE: 03/30/2023

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Linens & Hygiene Supplies:
Beds have the required linen supplies which include, pillowcases, mattress pads, fitted sheets, blankets, and bedspreads. An adequate supply of linen is stored in a closet in the hallway.

Emergency Phone Numbers, Exit Plan & Menu:
The exit plan and menu are posted and readily available for review throughout the home. There is one (1) fire extinguisher located in the dining area. A telephone line is available in the kitchen (310-325-1879). Emergency supplies and Personal Protective Equipment supplies are stored in the garage. The applicant’s Mitigation Plan was approved by CCLD.

Food Service:
All kitchen areas are clean and free of litter, rodents, vermin, and insects. The refrigerator and freezer are clean and of adequate size. The freezer is maintained at 0 degrees Fahrenheit and the refrigerator is below the required maximum of 40 degrees Fahrenheit. A two (2) day supply of perishable foods and a seven (7) day supply of non-perishable food were observed. All equipment, appliances, dishes, and utensils are clean and well maintained.

Smoke Detectors:
Smoke and carbon monoxide detectors throughout the interior space are operable.

Toxins:
All toxins are locked and stored in the garage.

Water Temperature:
The water temperature is 122.4 degrees Fahrenheit in the common resident bathroom.

Medications, First-Aid Kit & Book:
A first aid kit is stored in a locked cabinet which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze, and current first aid manual locked and inaccessible to clients. The client's medications are stored in a locked cabinet in the dining area.

REPORT CONTINUED IN LIC-809C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SWEET CARE MANOR	FACILITY NUMBER: 198320358
	VISIT DATE: 03/30/2023

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Clients & Staff Files:
The applicant will not be handling the cash resources of the resident. Records of staff and residents are stored in a locked cabinet in the living room.

Reading Material, Games, Equipment & Materials:
The facility has board games, books, magazines, bingo and other recreational materials for the residents’ use all stored in the family.

Pool/Jacuzzi & Pets:
There are no pets, jacuzzi, or pool in the property.

Fire clearance:
A Fire Clearance inspection was conducted on 1/25/2023 with approval for a capacity of six (6) individuals of which four (4) are non-ambulatory and two (2) are bedridden.

Component III:
The applicant has not completed the Comp III training during today’s visit.

During the pre-licensing inspection, certain items were observed which do not comply with applicable laws and regulations; the following items must be corrected, and proof of correction shall be submitted to the CCLD office to the attention of LPA Montoya by 4/10/2023. If additional time is required to complete noted items to correct, then the applicant will request an extension in writing prior to the due date. Some items may require a follow-up inspection verification of corrections.

The water temperature is 122.4 degrees Fahrenheit in the common resident bathroom.

REPORT CONTINUED IN LIC 809C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SWEET CARE MANOR	FACILITY NUMBER: 198320358
	VISIT DATE: 03/30/2023

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2. Client records are incomplete.
3. Patio sliding door is not properly working.
4. No cover/umbrella in the patio.
5. Water heater housing is not in good repair.
6. Window blinds in bedroom #2 is not in good repair.
7. Closets in bedrooms #1 and #4 need doors.
8. Need touch up paint in bedroom #1.
9. Small hole on the ceiling in staff bedroom needs to be repaired.
10. Check if two exposed electrical/phone lines in the patio are live or not.
11. Clear the two storage rooms.
12. Remove or cover the post light at the back patio.

An exit interview was conducted, and a copy of this report has been furnished to Applicant Charesa Reyes. LPA Montoya will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to their application.

END OF REPORT

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC809 (FAS) - (06/04)

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