191201966-9-11-2023-29-AS-BBAI-CVKU6M-20230911151833

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191201966
Report Date: 09/11/2023
Date Signed: 09/11/2023 03:24:07 PM

Document Has Been Signed on 09/11/2023 03:24 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 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: 135	DATE:	09/11/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Lorena Soria - Administrator		TIME COMPLETED:	03:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPAs) Brian Balisi and Martha Arroyo arrived at the facility unannounced to conduct a required annual visit at 9:30am. Upon arrival LPAs met with Administrator Lorena Soria and explained the reason for the visit. The LPAs toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. At 10:00am, a tour of the physical plant was conducted. 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 areas: DINING ROOMS / KITCHENS: Knives and sharp objects observed to be kept inaccessible to residents in care. Kitchen appliances appeared to be in operable condition. LPA's observed a sufficient supply of perishable and non-perishable food in each building. At 10:35am LPAs observed a resident playing piano and a group of other residents doing activities in the recreation room of the Lodge. COMMON AREAS: LPAs inspected the common areas throughout the buildings. The common areas were observed to be properly furnished and relatively clean at the time of the visit. LPsA observed appropriate signage regarding infection control posted throughout the facility. LPAs observed sanitizer readily available in areas with high touch surfaces. Dining room furniture was observed to be in good condition in each building. The facility maintained a comfortable temperature in each building. Smoke detector(s) and carbon monoxide detectors were operational at the time of the visit. Fire extinguishers were observed throughout the facility, fully charged and were last serviced Jan 19, 2023.Last Emergency drill was conducted in August. The LPAs observed required postings throughout the common spaces.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023

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: 09/11/2023

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BEDROOMS: LPAs inspected (30) randomly selected bedrooms throughout the Cottages, The Lodge and The Villa. The resident bedrooms were properly furnished with a bed, night stand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPAs observed all bathrooms in each resident bedroom were clean, properly supplied and had functional fixtures. The hot water was measured in each bathroom within 105 - 120 degrees Fahrenheit. Resident bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels.

RECORDS: Records review began at 12:30pm, eight (8) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. Eight (8) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order at this time.

MEDICATIONS: Medications review began at approximately 02:30pm The medications are centrally stored and inaccessible to residents in care. Medications are properly documented on the centrally stored medications and destruction record.

INFECTION CONTROL: Upon entry, each building has a central entry point for symptom screening, temperature checks, and sanitation station. At this time, the staff will continue to keep up signs that promotes good hand hygiene and symptoms of communicable diseases. 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 a single isolation room if the facility has a confirmed case of a communicable disease. The facility’s policies and procedures as it pertains to infection control are adequate at this time.

Between 10am - 2:30pm the LPAs interviewed seven (7) staff members and five (5) residents. LPAs obtained the following documents - Census, Staff schedule, and updated Limited Liability insurance.

Exit interview conducted and copy of report issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023

LIC809 (FAS) - (06/04)

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