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Inspection visit

Routine inspection

EVERGREEN HAVENLicense 1982007051 citation on this visit
1 citation recorded

Inspector’s narrative

What the inspector wrote

On 12/19/25 at 1:20pm, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Annual Visit to the facility listed above. LPA met with Administrator, Arlene Feliciano, and the purpose of today's visit was explained. LPA was granted entry into the facility. The facility is licensed for six (6) non-ambulatory residents ages 60 and over with an approved Hospice Waiver for one (1) resident. Structure/Physical Plant The facility is a single-story structure located in a residential neighborhood. It consists of the following: six (6) residents’ rooms, staff room, four (4) bathrooms, living room, sitting area, dining area, kitchen and outside covered patio area. LPA observed all walkways outside of the facility to be clean, clear, and free of debris, obstructions and hazards. LPA did not observe any bodies of water on the premises. Bedrooms LPA inspected all residents’ bedrooms and observed them to be clean and in good repair. All rooms were observed with the required furniture including a bed, dresser, nightstand, chair, and ample storage space for resident’s personal belongings. All beds were observed to have the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillow. All linens were observed in good repair. LPA observed an adequate supply of linens. All bedrooms were observed to have ample lighting. Bathrooms LPA inspected all bathrooms and were found to be within Title 22 regulations. All bathrooms were observed clean, operable, and in good repair. All bathrooms had secured safety handrails, shower chairs, and a nonskid mat. The showers were free of mildew and/or mold. LPA observed an ample supply of personal hygiene products and towels in good repair. The water temperature in the bathrooms measured 114.7-degrees, 114.5-degrees, 118.7- degrees and 115.1-degrees Fahrenheit. Kitchen LPA inspected the kitchen and found it to be clean and sanitary. LPA observed an ample supply of cookware, dining ware, and cutlery in good repair. LPA observed a 3-day supply of perishable foods and a 7-day supply of non-perishable foods properly labeled, dated, and stored. All appliances were observed operable. The water temperature measured 108.1-degrees Fahrenheit. LPA observed all sharps secured in a locked drawer in the kitchen and are inaccessible to residents. LPA observed cleaning supplies secured in a cabinet under the kitchen sink and are inaccessible to residents. Common Rooms LPA inspected all common rooms and observed the facility appropriately furnished. The living room has a large couch and chairs to accommodate all residents. The sitting area has multiple chairs and a couch to accommodate residents. LPA observed a fireplace screened and inaccessible to residents. The dining room has a large rectangular table with six chairs to accommodate all residents. LPA observed games, puzzles, magazines, and books stored in the dining room for residents. The facility was maintained at a comfortable temperature. LPA observed all walkways and hallways in the facility to be clean, clear, and free of hazards. Medications LPA observed centrally stored medications secured in a locked cabinet in the kitchen and are inaccessible to residents. All medications were observed in their original packaging. LPA reviewed the medications and Medication Administration Records (MARs) for four (4) residents. LPA observed the residents’ MARs and medication are consistent with properly documented records. Files LPA reviewed six (6) Resident files and observed the files contain the required documents. LPA reviewed the Administrator and two (2) staff files and observed they contained the required documents, clearance, and training. LPA reviewed the staff training logs and observed staff have the required training hours. Safety LPA observed all required signs and documents posted throughout the facility. LPA reviewed and received a copy of the facilities Liability Report which expires on 12/29/25 through Acord. Smoke detectors and Carbon Monoxide detectors are operable. LPA observed two (2) fully charged fire extinguishers last serviced on 04/25/25. The last facility inspection from the Torrance Fire Department was in October 2025. LPA inspected the First Aid Kit and found it contained the required items. The last emergency drill was conducted on 09/21/25. The facility has a working landline telephone. There are no firearms or ammunition stored at the facility. Infection Control Upon entry LPA observed a sign-in for visitor and a hand sanitizing station at the front door. LPA observed mandated infection control signs posted throughout the facility. LPA observed a 30-day supply of Personal Protective Equipment (PPE). Deficiency cited under California Code of Regulation Title 22 Division 6 Chapter 8 are being cited on the attached LIC 809-D. An exit interview was conducted with Administrator, Arlene Feliciano, and a copy of this report and Appeals Rights was provided.

Citations

1 citation recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 1569.618(c)(3)Type B

    Based on observation and record review, the licensee did not comply with the section cited above in three (3) out of three (3) Staff S1-S3 had CPR cards that expired on 10/17/2025, which poses/posed a potential health, safety or personal rights risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the December 19, 2025 inspection of EVERGREEN HAVEN?

This was a inspection inspection of EVERGREEN HAVEN on December 19, 2025. 1 citation were issued: 1 Type B.

Were any citations issued to EVERGREEN HAVEN on December 19, 2025?

Yes, 1 citation was issued (0 Type A, 1 Type B). The first citation was for: "Based on observation and record review, the licensee did not comply with the section cited above in three (3) out of thr..."

What type of inspection was this?

This was a inspection inspection. inspection inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLDView original report

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