195850240-8-9-2023-29-AS-CYEE-CUJUAW-20230809152525

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850240
Report Date: 08/09/2023
Date Signed: 08/09/2023 03:25:30 PM

Document Has Been Signed on 08/09/2023 03:25 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 NORTH, 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: 274	DATE:	08/09/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Joyce Aquino, Director of Resident Care Svcs		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 Analyst (LPA) Christine Yee conducted an unannounced case management visit as a result of the fire in the facility kitchen. LPA Yee met with Joyce Aquino, Director of Resident Care Services and the reason for today's visit was explained. Per interview with Joyce Aquino, the facility was in the process of extending the gas line in the kitchen for an additional fryer. The vendor who was hired to extend the gas line did not turn off the gas and the flames from the nearby stoves sparked the fire around 4:20pm on 8/8/23. The fire alarms, Ansul system and fire sprinklers were triggered. Residents located on the first, second and third floor of Building A were evacuated to the sidewalk in front of the facility . The vendor sustained first degree burns and was taken to the hospital. The fire was put out before the fire department arrived. All the fire department had to do was to reset the fire alarms. Per information provided, the fire was localized to the area where the air fryer and the kitchen stoves are located. There was only fire damage to the ceiling panels and the food that was being prepped for dinner, in addition to the water damage caused by the fire sprinklers. There were no structural damage to the kitchen, courtyard or room #323 - #326, located above the kitchen. The kitchen equipment and surrounding areas were not impacted and are operational. The dry food in the walk in storage, the freezer and refrigerator were not damaged. The facility immediately contacted the Emergency Response team at the Department of Public Health(DPH) and they arrived at the facility at around 7:20pm to assess the condition of the kitchen and the kitchen was closed. DPH needs to inspect and clear the kitchen before the kitchen can be re-opened. The fire in the kitchen also disrupted electricity to the 26 residents residing in Building B from 12am-8am this morning. Per Joyce, the facility generators were not triggered. All the residents were provided with emergency flash lights. The 26 residents in Building B are not on continuos oxygen were not impacted by the lack of electricity. Per Joyce, the residents' families were notified of this incident via the facility's K-4 Connect system. Continued on LIC809-C

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

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
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VARIEL OF WOODLAND HILLS, THE	FACILITY NUMBER: 195850240
	VISIT DATE: 08/09/2023

NARRATIVE

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At 11:58am, LPA Yee conducted a tour of the kitchen. The following repairs have been conducted or scheduled to be conducted to make the kitchen operational:

On the evening 8/8/23, the facility retained the services of a vendor to remove all the water from the kitchen.
Another vendor was retained to clean out the rest of kitchen this morning including all dishes, pots, pans and eating utensils need to be washed. During the tour of the kitchen, a plumber was observed working on draining the gas pipes so that the gas could be turned back on.
The panel to the Ansul system was observed open, and needs to be recharged and the anticipated time is today but no later than tomorrow.
The impacted ceiling panels were removed and pending replacement once the Ansul system is recharged and it is anticipated to be done this evening.
A second cleaning to be conducted once the ceiling panels are replaced.
Contact DPH to schedule clearance once the cleaning has been completed

While the kitchen is shut down, the facility is ordering food from local restaurants for all their meals and using disposal utensils. Dinner on the night of the fire was ordered from Stone Fire Grill and delivered around 5:30pm or 5:45pm, breakfast was picked up by staff from Dunkin Donut and Western Bagel, today's lunch and Dinner were ordered from Brent's Deli. A written meal plan to ensure that residents are being provided with their meals until the kitchen is re-opened was requested from Joyce by the end of business today.
Joyce Aquino was also advised to keep the Department informed when the kitchen is cleared by DPH and if there are any delays in the re-opening of the facility kitchen.

Exit interview was conducted.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023

LIC809 (FAS) - (06/04)

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