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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601665
Report Date: 10/15/2021
Date Signed: 10/26/2021 08:33:35 AM

Document Has Been Signed on 10/26/2021 08:33 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ELEGANT CARE INC.FACILITY NUMBER:
198601665
ADMINISTRATOR:JEWEL REESEFACILITY TYPE:
740
ADDRESS:834 E. 74TH ST.TELEPHONE:
(323) 821-1601
CITY:LOS ANGELESSTATE: CAZIP CODE:
90001
CAPACITY: 6CENSUS: 5DATE:
10/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Facility AdministratorTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Elizabeth Irra conducted an unannounced Required-1 year visit focusing on COVID-19 Infection Control Practices. LPA was allowed entry by Facility Administrator and explained the purpose of today's visit.

The following were observed/inspected:
  • COVID-19 Infection Control Practices (including signs) were observed.
  • Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing.
  • Hand soap dispensers and paper towel dispensers are located at the entrance and hallway.
  • Hand sanitizer observed inside resident rooms and throughout the facility.
  • Per Administrator (4) residents are fully vaccinated, (1) resident refused the vaccine and all staff are fully vaccinated.
  • Staff and Residents are completing COVID testing on a weekly basis.
  • PPE supplies observed. Additional supplies are located inside the storage room.
  • Incontinence care supplies observed. Additional supplies are located inside the storage room.
  • Staff responsible for direct care and supervision were observed wearing masks.
  • Sufficient supply of perishable for 2 days and non-perishable foods for 7 days were observed.
  • Residents were socially distanced according to local public health guidelines.


LPA was experiencing technical difficulties during today's visit.

Exit interview conducted, a copy of this report and Appeal Rights were provided to Facility Administrator.
SUPERVISORS NAME: Christine Yee
LICENSING EVALUATOR NAME: Elizabeth Irra
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2021
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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