191201966-8-26-2021-29-AS-BBAI-C69RQC-20210826131318

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191201966
Report Date: 08/26/2021
Date Signed: 08/26/2021 01:14:11 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	MOTION PICTURE & TELEVISION FUND		FACILITY NUMBER:	191201966
ADMINISTRATOR:	LORENA SORIA		FACILITY TYPE:	740
ADDRESS:	23388 MULHOLLAND DRIVE		TELEPHONE:	(818) 876-1208
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91364
CAPACITY:	241	CENSUS: 142	DATE:	08/26/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Lorena Soria - Administrator		TIME COMPLETED:	01:30 PM

NARRATIVE

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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced required annual visit with an emphasis on infection control practices and procedures. Upon arrival LPA met with Administrator Lorena Soria and explained the reason for the visit.

At 10:30am, a tour of the physical plant was conducted with Administrator. There are three separate residential areas for the licensed facility: Cottages, Lodge, and Villa. The Cottages are for higher functioning residents, the Lodge is assisted living, and the Villa is a mix of high functioning residents and assisted living. Required postings were observed in various areas of the facility.

KITCHEN: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. BEDROOMS: The client bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. RESTROOMS: Restrooms are clean, sanitary and in operating condition. The common bathrooms were observed with appropriate signs and stocked with paper towels. Common Areas: These included activity rooms, dining rooms, and libraries. The common areas appeared clean and were properly furnished. Surrounding Grounds: Entry/exits were free of obstruction. The outdoor areas were clean and free of hazards.

The LPA observed required postings on entry ways. Throughout today’s visit, LPA observed appropriate signs in common areas that promoted hand hygiene, physical distancing, and cough/sneeze etiquette. The LPA advised Administrator to place additional signs throughout the facility specifically in high traffic areas and hallways. The LPA observed sanitizer throughout the facility.

Continued on 809-C

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: MOTION PICTURE & TELEVISION FUND	FACILITY NUMBER: 191201966
	VISIT DATE: 08/26/2021

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Continued from 809

INFECTION CONTROL: The LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate an entire wing if the facility has a confirmed case of COVID-19. COVID-19 testing is conducted every two weeks for unvaccinated staff and once a month for residents who are unvaccinated. The facility’s policies and procedures as it pertains to infection control are adequate.

No deficiencies cited. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

LIC809 (FAS) - (06/04)

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