Lakewood Palace HC

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Luis Mora and Nicol Wesley conducted an unannounced annual visit at the facility using the CARE Tool. LPA Mora met with Elvira David (Administrator) and explained the reason for the visit. The facility is licensed to serve 6 residents over the age of 60, four non-ambulatory and approved for two hospice waivers. The facility is operating within the scope of its license. A tour of the single-story facility included: kitchen, dining area, living room, 3 resident bedrooms, 3 bathrooms, laundry room, backyard, and attached garage. LPAs and Elvira David toured the facility and the following was observed: sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen and garage. Auditory devices were seen on all exit doors which are required for dementia residents and were operating at the time of the visit. The water temperature was tested in all 3 bathrooms and measured at 107 degrees F, 107.7 degrees F, and 106.8 degrees F which is within the required 105 - 120 degrees F. The bathrooms are clean and have the required grab bars in the shower and near the toilet for non-ambulatory residents. Showers also have non-skid materials. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Resident beds have the required linen and the linen is in good condition. There is extra clean linen and towels in each resident bedroom’s closet. Smoke detectors were observed in each room and throughout the facility and are properly operating. Carbon monoxides were observed in the kitchen and living room and are properly operating. Fire extinguishers were observed in the kitchen and living room which are fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps are kept locked in a kitchen cabinet. Cleaning supplies and toxins are kept locked in a laundry room cabinet. First Aid kit was fully stocked with current manual and it is kept in the medication closet. The front and backyard are well maintained. There is a shaded seating area for the residents located in the backyard. There are no bodies of water at the facility. Passageways and exits are free of obstruction. (Continued to LIC 809-C) Residents medication are centrally stored in a locked closet in the dining area. Residents and staff files are centrally stored in a dining area cabinet. LPA reviewed medication for all 5 of the residents and observed that medications are documented properly and given as prescribed. LPA reviewed files for all 5 residents and 4 staff. No issues were found with the files. LPA observed administrator certificate for Elvira David – 6009328740 with an expiration date of 05/16/2024. LPA interviewed 2 staff and 2 residents. Per California Code of Regulations, Title 22, and California Health and Safety Code, there was no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 14, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit at the facility with focus on the infection control domain, medication and food review. LPA Mora met Administrator Elvira David and explained the reason for the visit. The facility is licensed to serve 6 residents over the age of 60, four non-ambulatory and approved for two hospice residents. The facility is operating within the scope of its license. The facility is located in a residential area. A tour of the single-story facility included: kitchen, dining area, living room, 3 resident bedrooms, 3 bathrooms, laundry room, backyard, and attached garage. LPA and Elvira David toured the facility and the following was observed: sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen and garage. Auditory devices were seen on all exit doors which are required for dementia residents and were operating at the time of the visit. The water temperature was tested in all 3 bathrooms and measured at 15.6 degrees F, 105.8 degrees F, and 105.4 degrees F which is within the required 105 - 120 degrees F. The bathrooms are clean and have the required grab bars in the shower and near the toilet for non-ambulatory residents. Showers also have non-skid materials. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have enough closet space. Resident beds have the required linen and the linen is in good condition. There is extra clean linen and towels in each resident bedroom’s closet. Smoke detectors were observed in each room and throughout the facility and are properly operating. Carbon monoxides were observed in the kitchen and living room and are properly operating. Fire extinguishers were observed in the kitchen and living room which are fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps are kept locked in a kitchen cabinet. Cleaning supplies and toxins are kept locked in a laundry room cabinet. First Aid kit was fully stocked with current manual and it is kept in the medication closet. The front and backyard are well maintained. There is a shaded seating area for the residents located in the backyard. There are no bodies of water at the facility. Passageways and exits are free of obstruction. (CONTINUED TO LIC 809C) Residents medication are centrally stored in a locked closet in the dining area. Residents and staff files are centrally stored in a dining area cabinet. LPA reviewed medication for all 5 of the residents and observed that medications are documented properly and given as prescribed. LPA reviewed files for all 5 residents and 3 staff. No issues were found with the files. LPA observed administrator certificate for Elvira David – 6009328740 with an expiration date of 05/06/2024. Facility is following COVID 19 recommendations regarding screening visitors, staff, and residents. Signs are posted throughout the facility, and hand-washing signs were observed in bathroom. Sufficient hand soap, hand sanitizer, and paper towels were observed. Supply of 30-day Personal Protective Equipment (PPE) was observed in the garage. Per California Code of Regulations, Title 22, and California Health and Safety Code, there was no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 31, 2022

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst(LPA) Nicol Wesley conducted an unannounced Required 1 year (annual continuation) year inspection at the facility and met with Administrator Elvira David and explained the purpose for todays visit. Prior to the visit LPA Wesley conducted a risk assessment for on-site inspections. The facility phone number is 562 924 3132. The facility is a two story home that consist of (5) five bedrooms(2 for staff), (4) bathrooms(1 for staff). kitchen, laundry area, living room, dining room. The first level consists of (3) resident bedrooms and (3) resident bathrooms, family room, kitchen, TV area, and laundry room, back yard with outside shaded area, and a Garage. The second level(upstairs) is designated for staff use only, which consists of (2) bedrooms and (1) one bathroom. The facility is licensed for 6 residents age 60 and above, in which 4 can be non ambulatory, and there is a Hospice waiver for a total of 2 residents. A Pre screening area with PPE supplies was observed upon entry into the facility. LPAs observed the supply of food. Resident medications, and medication logs were reviewed. LPA toured the entire physical plant and observed: Resident Bedroom #1(bathroom #1), Bedroom #2(bathroom #2), Bedroom #3, and Bathroom #3 to have all required furniture, and the bathrooms and showers are operable. During the visit the Infection control domain was used and the following areas were observed/inspected: The facility had all postings at the front entrance, bathrooms, throughout the facility, and back exit door(family room). Hand sanitizing gel and masks were located at the entry of each room. The smoke detectors/carbon monoxide detector are operable. There are a total of 5 fire extinguishers(kitchen, family room, patio, garage, and 2nd flood hallway). The water temperature was tested and measured 113.7 degrees F. The final mitigation report was received on 07/26/21. Administrators certificate for Elvira C. David #6009328740 expires on 05/16/2022. There are no deficiencies cited during todays visit. Exit interview conducted.the state’s words, verbatim · CDSS document, Nov 9, 2021

Type of visit: Required - 1 Year

Licensing Program Analysts(LPAs) Luis Mora and Nicol Wesley conducted an unannounced Required 1 year inspection at the facility and met with Administrator and explained the purpose for todays visit. Prior to the visit LPA Wesley conducted a risk assessment for on-site inspections. The facility phone number is 562 924 3132. The facility is a two story home that consist of (5) five bedrooms(2 for staff), (4) bathrooms(1 for staff). kitchen, laundry area, living room, dining room. The first level consists of (3) resident bedrooms and (3) resident bathrooms, family room, kitchen, TV area, and laundry room, back yard with outside shaded area, and a Garage. The second level(upstairs) is designated for staff use only, which consists of (2) bedrooms and (1) one bathroom. The facility is licensed for 6 residents age 60 and above, in which 4 can be non ambulatory, and there is a Hospice waiver for a total of 2 residents. A Pre screening area with PPE supplies was observed upon entry into the facility. LPAs observed the supply of food. Resident medications, and medication logs were reviewed. Due to time constraints LPA Wesley will return to resume the visit on another day. There were no deficiencies issued during todays visit. Exit interview conducted.the state’s words, verbatim · CDSS document, Aug 25, 2021