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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850240
Report Date: 10/12/2023
Date Signed: 10/12/2023 09:40:24 AM


Document Has Been Signed on 10/12/2023 09:40 AM - 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:VARIEL OF WOODLAND HILLS, THEFACILITY NUMBER:
195850240
ADMINISTRATOR:JOYCE AQUINOFACILITY TYPE:
740
ADDRESS:6233 VARIEL AVETELEPHONE:
(818) 651-6018
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:436CENSUS: 294DATE:
10/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:44 AM
MET WITH: Jessica Saks, Director of NursingTIME COMPLETED:
09:45 AM
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Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced Case Management visit to this location. At 8:45 a.m., the LPA met with the staff and explained the reason for the visit. At 9:04 a.m., the LPA met with the Director of Nursing Jessica Saks and Executive Director Jim Biggs. The reason for today's inspection is to follow up on a self-reported incident from 10/11/2023, the facility reported that the main water line had burst, and that the facility water was shut off.

Between 9:07 a.m. and 9:24 a.m., the LPA and the Director of Nursing Jessica Saks, toured the facility. The LPA observed the following: gallons of water throughout the facility and resident rooms and catered food. The facility has sufficient amount of bottled water for resident and staff use. No immediate health and safety concerns were observed during today's inspection.

Exit interview conducted. A copy of the report was provided.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023
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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