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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191201966
Report Date: 09/20/2022
Date Signed: 09/20/2022 12:21:57 PM


Document Has Been Signed on 09/20/2022 12:21 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:MOTION PICTURE & TELEVISION FUNDFACILITY NUMBER:
191201966
ADMINISTRATOR:LORENA SORIAFACILITY TYPE:
740
ADDRESS:23388 MULHOLLAND DRIVETELEPHONE:
(818) 876-1208
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91364
CAPACITY:241CENSUS: 146DATE:
09/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Robert Gil - Director Hospitality Services TIME COMPLETED:
12:30 PM
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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 Robert Gil Director Hospitality Services and explained the reason for the visit. LPA spoke with Administrator Lorena Soria over the phone, who stated that Robert will sign for the report in her place.

At 09:30am, a tour of the physical plant was conducted with Robert. 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. .


The following was observed for the three residential area:
KITCHEN: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food properly stored. Kitchens were observed inaccessible to residents at this time. BEDROOMS: The client bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. RESTROOMS: Common area Restrooms were observed clean, sanitary and in operating condition. The common bathrooms were observed with appropriate signs and fully supplied. 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 observed sanitizer throughout the facility. Fire extinguishers were observed throughout the property, fully charged and last serviced in September 2022.

Continued on 809-C

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian BalisiTELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2022
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: 09/20/2022
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Continued from 809

INFECTION CONTROL: The LPA spoke with the Robert 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 currently being conducted twice a week, which will switch to once a week once the facility is in the green. The facility’s policies and procedures as it pertains to infection control are adequate at this time.

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

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian BalisiTELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022
LIC809 (FAS) - (06/04)
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