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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191221435
Report Date: 01/23/2025
Date Signed: 01/23/2025 02:42:57 PM

Document Has Been Signed on 01/23/2025 02:42 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:BROOKDALE CHATSWORTHFACILITY NUMBER:
191221435
ADMINISTRATOR/
DIRECTOR:
TIERNY DENISE WILBURNFACILITY TYPE:
740
ADDRESS:20801 DEVONSHIRE BLVDTELEPHONE:
(818) 341-2552
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY: 268TOTAL ENROLLED CHILDREN: 0CENSUS: 115DATE:
01/23/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Amanda Monroy-Executive Director TIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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At 9:00 am, Licensing Program Analysts (LPAs), Nadia Shahbazian and Angela Panushkina conducted a Case Management visit. LPAs met with the Executive Director, Amanda Monroy, and explained the reason for the visit.

At 9:10am, LPAs requested resident and staff roster. At approximately 9:25am, LPAs conducted a physical plant tour, to ensure health and safety of the residents are protected.

During the 12/17/24 visit, LPA Panushkina was informed that the facility had approximately thirty seven (37) non-ambulatory residents residing on a second floor. During todays visit, LPAs informed that the facility currently has twenty seven (27) non-ambulatory residents residing on the second floor. Also, LPAs were informed that on December 2024 facility hired an Architect who is currently working on a plan to be approved by the Building and Safety Department. LPAs obtained the copy of documents. Additionally, LPAs were informed that the facility is working with the Fire Inspector to make appropriate changes to expedite the new plans for the second floor non-ambulatory approval. Lastly, Administrator informed LPAs that the facility staff continues to conduct routine checks on non-ambulatory residents, on a 2nd floor, every two (2) hours.

No deficiency issued during todays visit.
Exit interview conducted and copy of this report signed and delivered.
Eva MillerTELEPHONE: (818) 596-4373
Nadia ShahbazianTELEPHONE: (818) 476-6033
DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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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