Crown Manor

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) N. Galarza arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation. LPA was greeted and granted entry by caregiver staff. Administrator Kevin Bim arrived later on to assist with inspection. Administrator has a valid administrator's certificate expiring on 6/8/2027. The following was observed during the inspection: Infection Control: The Infection Control Plan includes Environmental cleaning and disinfection activities. Operational Requirements: A Dementia and hospice waiver for 3 residents has been approved. A fire clearance for 5 non-ambulatory adults 60 and over; and one (1) may be bedridden resident. Facility does not handle resident P & I monies. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current. Physical Plant/Environment Safety: The interior and exterior physical plant was inspected. The facility is a single-story home located in a residential area consisting of three (3) resident bedrooms, one (1) live-in staff room, two (2) full bathrooms, kitchen, dining room, living room, laundry room, detached garage, and a covered backyard patio area. Rooms are equipped with required furniture, bedding and mattress pads. Cleaning supplies and toxic substances are inaccessible to residents. The facility has a fire extinguisher. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Smoke and carbon monoxide detectors were tested and are operational. The facility maintains emergency food supply and water. Emergency Phone numbers, exit plan and programming schedules were posted. The facility has central air conditioning and heating. First aid kits/Manuals are kept in activity rooms; consisting of thermometer, tweezers, scissors, antiseptic, bandages, gauze. Exit doors are free of any obstruction. The last Emergency Disaster drill was conducted on 7/13/2026. Staffing: A total 4 staff members provide care and supervision to the residents. Personnel Records/Staff Training: Four (4) staff files were reviewed. Proof of staff training, health clearance, and 1st Aid/CPR training is current in files. Staff have criminal background clearance. Staff (S4) is not associated to the facility. A citation/civil penalty was issued. Resident Records/Incident Reports: A total of five (5) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisals, TB clearance, Physician's Orders, medical consent. However, residents R1, R3 and R4's Medical Assessments and Appraisals are not current. Citations were issued. RCFE complaint poster and Personal rights were observed posted. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. The facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Four residents have modified diets. Incident Medical and Dental: Centrally stored / 30-Day supply of medications were reviewed. Medical and dental transportation is provided by family. *There were 3 unlocked medication bottles without a label on top of the kitchen table, staff stated they belonged to R1 and are transferred when the medications are not administered. A citation was issued. Disaster Preparedness: Emergency and Disaster Plan LIC 610E was reviewed. Facility has a First Aid Kit and Manual. Residents with Special Health Needs: No residents are currently enrolled in hospice services, two (2) residents receive home health services, one resident has a prohibited health condition (g-tube), and one resident is bedridden. A citation was issued. Pursuant to Title 22, deficiencies were observed and are cited. An exit interview was conducted with Administrator Kevin Bim. A copy of the report/appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 27, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Jull Pestano, caregiver for the facility, and explained the purpose of the visit. Administrator Kevin Bim arrived shortly thereafter. There are five (5) residents currently living in the facility. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: · Infection control plan is on file. Physical Plant/Environment Safety: · The facility is a single-story home located in a residential neighborhood. It is licensed for a capacity of six (6) residents, all six (6) of whom may be non-ambulatory, one of whom may be bedridden, and a hospice waiver approved for three (3) residents. The facility consists of a kitchen, a dining room, a living room, four (4) resident bedrooms, a staff bedroom two bathrooms of which Restroom #1 had a hot water temperature reading of 107.5 Degrees Fahrenheit, and Restroom #2 which had a hot water temperature reading of 113.5 Degrees Fahrenheit. The facility was observed to be in good repair. · The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. The facility has a fully charged fire extinguisher kept in the facility. Operational Requirements: · The Program Design was reviewed. · Care and supervision to meet the clients’ needs was observed. Staffing: · Five (5) full-time staff members provide care and supervision to the clients. Personnel Records/Staff Training: · Five (5) staff files were reviewed for criminal background clearance and training. · All Five (5) staff records reviewed have a health screening with a Tuberculosis clearance, and five (5) staff have First Aid/CPR trainings that are active. · The administrator’s certificate expires on 6/8/2027. Resident Rights/Information: · Physician orders were reviewed for five (5) resident files. · Medications were also reviewed for five (5) residents. Resident Records/Incident Reports: · Five (5) resident files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, Appraisal/Needs and Services Plan, personal rights, medical consent, and medication records were reviewed. Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Incident Medical and Dental: · All residents have an Appraisal/Needs and Services Plan on file. · Staff training was on file. Disaster Preparedness: · Emergency and Disaster Plan (LIC610E) was posted in the facility. · The last emergency and disaster drill was conducted on 6/15/2025. Planned Activities: · Sufficient Space is provided to accommodate both indoor and outdoor activities. · Sufficient equipment and supplies are provided to meet the requirements of the activity program. Residents with Special Health Care Needs · There is an adequate number of staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her appraisal. Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies were observed. Exit interview held and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 15, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced Required 1-year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Aissa Madrid, caregiver for the facility, and explained the purpose of the visit. Administrator Kevin Bim arrived shortly thereafter. There are four (4) non-ambulatory and one (1) bedridden residents residing within the home. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: · Infection control practices were observed. · Infection control plan is on file. Physical Plant/Environment Safety: · The facility is a single-story home located in a residential neighborhood. It is licensed for a capacity of six (6) residents, one (1) of which may be bedridden and the remaining five (5) may be non-ambulatory, as well as a hospice waiver approved for three (3) residents. The facility consists of a kitchen and dining room which contains the facility’s washer and dryer machines, a living room, four (4) resident bedrooms, a backyard area, and two (2) resident bathrooms of which Restroom #1 (R1) had a hot water temperature reading of 107.4 degrees Fahrenheit, and Restroom #2 measured at 109.9 degrees Fahrenheit. The facility was observed to be in good repair. ·The interior and exterior physical plant was inspected. Exit doors are free of any obstruction. · Water temperature readings for one of the bathrooms in the home did not fall within the required range of 105 - 120 degrees Fahrenheit. Operational Requirements: · The Program Design was reviewed. · Fire clearance was approved by LA County Fire Department for a capacity of six (6) residents, one (1) of which may be bedridden and the remaining five (5) may be non-ambulatory, as well as a hospice waiver approved for three (3) residents. · Care and supervision to meet the clients’ needs was observed. Staffing: · Three (3) full-time staff members provide care and supervision to the clients. Personnel Records/Staff Training: · Three (3) staff files were reviewed for criminal background clearance and training. · All staff records reviewed have health a health screening with a Tuberculosis clearance, and all staff have First Aid/CPR trainings that are active. · The administrator’s certificate expires on 6/8/2025. Resident Rights/Information: · Physician orders were reviewed for five (5 resident files. · Medications were also reviewed for five (5) residents. Resident Records/Incident Reports: · Five (5) resident files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, Appraisal/Needs and Services Plan, personal rights, medical consent, and medication records were reviewed. Food Service: · The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. Incident Medical and Dental: · All residents have an Appraisal/Needs and Services Plan on file · Staff training was on file. Disaster Preparedness: · Emergency and Disaster Plan was publicly posted and found within the facility. · The last emergency and disaster drill was conducted on 6/12/2024. Planned Activities: · Sufficient Space is provided to accommodate both indoor and outdoor activities. · Sufficient equipment and supplies are provided to meet the requirements of the activity program. Residents with Special Health Care Needs: · There are three (3) residents who receive services from home health agencies, and the facility has the agreement with the home health agencies documented and on file. · There is an adequate number of staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her appraisal. Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies were observed during the visit. Exit interview held and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 23, 2024