195850240-6-12-2023-29-AS-AASO-CSQVP7-20230612163616

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850240
Report Date: 06/12/2023
Date Signed: 06/12/2023 04:38:12 PM

Document Has Been Signed on 06/12/2023 04:38 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:	VARIEL OF WOODLAND HILLS, THE		FACILITY NUMBER:	195850240
ADMINISTRATOR:	JOYCE AQUINO		FACILITY TYPE:	740
ADDRESS:	6233 VARIEL AVE		TELEPHONE:	(818) 651-6018
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	436	CENSUS: 239	DATE:	06/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:29 AM
MET WITH:	Joyce Aquino		TIME COMPLETED:	04:50 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 (LPA's) Angel Ascencio and Ashley Morgan conducted a required annual training for the above facility. The LPA's met with Director of Resident Care Services (DRCS) Joyce Aquino at 09:30 a.m. Entrance interview conducted. The LPAs, along with ED Aquino and Maintenance Director Ray Rosales tour the facility inside and out to ensure the facility is in compliance with Title 22 regulations. Facility Layout: The facility has three (3) buildings, which are named Building A, Building B and Building C. At 10:20 a.m., a physical plant tour was conducted. The facility has three hundred thirty-six (336) units. Building B has a Memory Care Unit on the 7th floor and there are three (3) delayed egress doors on 7th floor. The LPAs toured five (5) resident rooms in the Memory Care Unit. Rooms in the memory care unit are single occupancy and have no appliances. Lighting in the rooms appeared adequate. The rooms are set up with beds, night stands, lamps, chests of drawers, chairs and closet space. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. The rooms in Building A, Building B, and Building C (excluding the 7th floor Memory Care Unit) are equipped with a refrigerator, microwave, and sink, and in-unit washer and dryer. The rooms in Building A, Building B and Building C are majority single occupancy, with the availability of double occupancy in some rooms. The LPAs toured fifteen (15) additional resident rooms in Buildings A, B and C, which were observed in compliance. Building A has the following amenities and common areas: offices spaces, conference rooms, mail room and the bistro are located on the first floor. One (1) theater is located on the first floor and a second (2) theater is located on the second floor. The main kitchen and dining area are located on the second floor. Continued on LIC 809-C

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023

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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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: VARIEL OF WOODLAND HILLS, THE	FACILITY NUMBER: 195850240
	VISIT DATE: 06/12/2023

NARRATIVE

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The second-floor amenities include: art room, the tavern with locked cabinets, the marketplace, the activity/simulator room, wine cellar, outdoor terrace, and Wellness center. The third floor has a covered outdoor area with outdoor furniture for resident use.

Building B has the following amenities and common areas: pet washroom, salon, activities/conservatory room and a community garden. Throughout Building B there are community rooms and a covered outdoor area for resident use located on the third floor. Building C has the following amenities and common areas: a wellness center with gym equipment, a yoga room, a juice bar, a physical therapy room, a massage room, a laundry room and a salon. There is an in-ground pool which is kept locked on the first floor of Building C.

Common Spaces: Regarding the pendant system, the system is activated in the resident bedrooms and restrooms. All systems go directly to a computer at the front desk and to hand-held devices. Designated staff carry a handheld device, which displays the location of the alarm that has been pulled. Staff also utilize walkie-talkies to communicate with staff accordingly. There are cameras observed in exterior perimeter. The community’s smoke detectors and carbon monoxide detectors are hard wired and were serviced the Los Angeles Fire Department on 05/22/2023. The fire extinguishers are located on every floor in each building and were observed to be fully charged and serviced. There is a functioning telephone on the premises. The emergency exiting plans/sketch are posted in the hallways. The emergency telephone numbers are posted in the entryway. Other required postings are posted on the first floor of Building A, near the mail room and the common hallway. The LPAs observed the Ombudsman Poster and DSS Complaint Poster throughout the community.

Kitchen: The community had a sufficient supply of perishable and non-perishable food at the time of the visit. Appliances in the kitchen were clean and appeared functional. Snacks and beverages are available for residents in the Bistro. Food is prepared in the main kitchen, which is located in Building A on the second floor and is delivered to the separate dining rooms.

Grounds: Community has three vehicles for transportation needs – a seventeen (17) passenger bus, a six (6) passenger van, and a small SUV. There was a fountain observed in the courtyard; however, the community drained the water out of the fountain during the visit. There are approximately 275 parking spots available for residents and staff.
Continued on LIC 809 - C

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023

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: VARIEL OF WOODLAND HILLS, THE	FACILITY NUMBER: 195850240
	VISIT DATE: 06/12/2023

NARRATIVE

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Common and Resident Bathrooms: Bathrooms were equipped with grab bars near the toilet and shower/tub, and non-skid surfaces were observed in the shower/tub.

Infection Control: The community has a central entry point for symptom screening and temperature checks for staff, residents and visitors. There is hand sanitizer available throughout the community. The community has an adequate supply of Personal Protection Equipment (PPE) and the community is able to obtain additional supplies as needed. If needed, the community has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The community has a record of staff vaccinations and understands that they will need to maintain vaccination records for all residents that are vaccinated.

The following deficiencies were observed:

11:02 a.m - during a tour in the Memory Care unit, 5 rooms were observed to have a water temperature range of 121 - 130 degree F. Additionally, 7 resident rooms in Buildings A, B and C had a water temperature range of 121 - 130 degree F. 1 resident water temperature was measured 99.0 degree F.

02:33 p.m. - during tour in dinning room area, LPAs observed Windex/cleaning supplies accessible to persons in care.

Due to time constraints, the LPA will return at a later date to continue the inspection.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report and appeal rights provided to DRCS.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/12/2023 04:38 PM - It Cannot Be Edited

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: VARIEL OF WOODLAND HILLS, THE	FACILITY NUMBER: 195850240
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87309(a)

Storage Space

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations, the licensee did not comply with the section cited above as windex and other cleaning solutions were observed accessible which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 06/13/2023
	Plan of Correction
1 2 3 4	DRCS locked away items. DRCS will conduct staff training on section 87309(a) and sent copies of training to CCL by 06/14/2023.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/12/2023 04:38 PM - It Cannot Be Edited

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: VARIEL OF WOODLAND HILLS, THE	FACILITY NUMBER: 195850240
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87303(e)(2)

Maintenance and Operation

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as variousresident water temperature was observed to be over 120.0 degree F which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 06/14/2023
	Plan of Correction
1 2 3 4	Administrator will lower the temperature for buildings A,B,C. Administrator will take 3 times a day, for 3 days temperature reading on 15 random resident rooms and submit to CCL by 06/16/2023.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023

LIC809 (FAS) - (06/04)

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