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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602099
Report Date: 09/01/2023
Date Signed: 09/05/2023 12:15:57 PM

Document Has Been Signed on 09/05/2023 12:15 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 ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:CORAL OAKS CARE LIVINGFACILITY NUMBER:
198602099
ADMINISTRATOR:ELEANOR BARRIENTOSFACILITY TYPE:
740
ADDRESS:4271 CARLIN AVETELEPHONE:
(310) 763-4881
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY: 84CENSUS: 72DATE:
09/01/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:11 AM
MET WITH:Michalene Johson
TIME COMPLETED:
05:35 PM
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Licensing Program Analyst/ Ruby Velasco and Licensing Program Manager/ Eva Alvarez conducted an unannounced visit to this facility. The purpose of today’s visit was to conduct an Annual inspection. LPA met with Administrator/ Eleanor Barrientos and Assistant Administrator/ Michalene Johnson. Facility is licensed for 64 non-ambulatory residents and 10 bedridden residents. The facility no residents on Hospice and has no hospice waiver. The facility currently has 42 ambulatory residents and 30 non-ambulatory residents, who are residing in the facility. There are 5 residents diagnosed with mild Dementia residing in the facility. There are 6 residents receiving Home Health. The facility is handling residents’ money and have provided a copy of an active surety bond.

LPA toured the physical plant, inspected food service, reviewed staff records, and reviewed resident files. The facility conducted a fire drill on 7/22/23. The facilities consist of 42 resident bedrooms, 44 bathrooms, activity room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Bathrooms are clean, sanitary, and fixtures are working properly, The bathrooms are equipped with devices that provide assistance. The facility water temperature properly measured at 105-110 Degrees Fahrenheit. Resident bath towels, toiletries, and personal hygiene supplies were adequately stocked. Common areas were clean and hazard free. All doorways were free of obstructions.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ruby Velasco
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2023
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 ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: CORAL OAKS CARE LIVING
FACILITY NUMBER: 198602099
VISIT DATE: 09/01/2023
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Kitchen was inspected and observed to be in compliance with Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were inspected. Smoke detectors and Carbon monoxide detectors were tested and found to operating properly. The First Aid kit is fully stocked. Outside grounds were toured and no bodies of water were observed. Walkways around the facility were clear of hazards. There are no security bars or weapons on the premises.

A deficiency was cited 87465 (h)(2) under California Code of Regulations, Title 22, Chapter 1, Division 6, Chapter 8 and corrected at the time of visit.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ruby Velasco
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2023
LIC809 (FAS) - (06/04)
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