191802082-5-7-2025-31-AS-AAEA-DGFUW4-20250507155607

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191802082
Report Date: 05/07/2025
Date Signed: 05/07/2025 03:57:18 PM

Document Has Been Signed on 05/07/2025 03:57 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:	SOLHEIM SENIOR COMMUNITY		FACILITY NUMBER:	191802082
ADMINISTRATOR/ DIRECTOR:	MEG PIERCE		FACILITY TYPE:	741
ADDRESS:	2236 MERTON AVENUE		TELEPHONE:	(323) 257-7518
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90041
CAPACITY: 126	TOTAL ENROLLED CHILDREN: 0	CENSUS: 86	DATE:	05/07/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:45 PM
MET WITH:	Marie Garnett, Director of Nursing & Mike Gonzalez, Director Residential Health & Wellness		TIME VISIT/ INSPECTION COMPLETED:	04:10 PM

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At 9:45 a.m., Licensing Program Analyst (LPA), Antonia Alvizar-Ettima conducted an unannounced annual inspection at the facility mentioned above. LPA met with the Director of Nursing & Director Residential Health & Wellness. LPA explained the reason for the visit. At 10:30a.m., physical tour was conducted with the Director of Nursing. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools.

The facility is a two-story building with private and shared bedrooms, private bathrooms, kitchen, dining room, recreation rooms, common areas, patios, and outdoor areas. The facility has a Memory Care, Skilled Nursing, Residential Assisted Living and Independent Living. The facility has a fire clearance for one hundred and twenty-six (126) non-ambulatory residents, and a hospice waiver for seven (07) residents.

The facility has multiple fire extinguishers located throughout the facility and all have a service tag dated of 01/17/2025. The smoke detectors are tested monthly and based on the LPA observations of the monthly inspection reports that shows results as passed for all apartments. The facility is equipped with fire sprinklers.

Elevator: The facility has two (02) functioning elevators. LPA observed a posting for the facility’s emergency evacuation routes which was clearly labeled.

Living, dining room and common areas: The facility has three (03) patio areas for residents in care. LPA observed the outdoor patio area for memory care and residential assisted living to have sufficient table and chairs for seating under a cover area. The facility has multiple dining areas throughout the facility that has a kitchenette area (counter, sink and refrigerator) inaccessible to residents. No toxins or hazardous materials

Naira Margaryan	TELEPHONE: (818) 596-4368
Antonia Alvizar-Ettima	TELEPHONE: (818) 383-6108
	DATE: 05/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SOLHEIM SENIOR COMMUNITY	FACILITY NUMBER: 191802082
	VISIT DATE: 05/07/2025

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stored in these areas. The facility has bookshelves located in the hallways which are accessible to residents for enjoyment. All common areas are appropriately furnished with tables and chairs and adequate lighting. LPA observed the areas to be clean and free from debris. LPA observed a storage closet on the second floor near the elevator to be storing an emergency disaster kits, wheelchairs and extra linens and hand and bath towels. LPA also observed additional closets for extra linens.

Surrounding Grounds: The front grounds of the facility are well landscaped and have a leveled walkway to the entrance. All passageways were observed to be clear from obstruction and no bodies of water were observed.

Resident Files: LPA conducted a file review of six (06) randomly selected resident records to ensure compliance of licensing forms. Residents’ files appear to be complete and updated.

Staff Files: LPA conducted a review of seven (07) staff records and they all have criminal record clearances and associated to this facility. Staff have current first aid and training documentation showing training completed. Administrator's certificate was observed to be current.

Due to time constraints, LPA had to terminate the visit and will return on a later date to complete the Required - 1 Year inspection by inspecting kitchen, food, bathrooms, bedrooms, medication, laundry and interview residents.

An exit interview was conducted. A copy of this report was provided to the Director Residential Health & Wellness.

No deficiencies cited, exit interview conducted, copy of report signed and issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

LIC809 (FAS) - (06/04)

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