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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850339
Report Date: 11/15/2023
Date Signed: 11/15/2023 10:30:39 AM

Document Has Been Signed on 11/15/2023 10:30 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:INN AT THE PARK VENTURAFACILITY NUMBER:
195850339
ADMINISTRATOR:ANGUIANO, ROSEFACILITY TYPE:
740
ADDRESS:21200 VENTURA BLVDTELEPHONE:
(818) 884-7100
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91364
CAPACITY: 200CENSUS: 159DATE:
11/15/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Rose Anguiano - AdministratorTIME COMPLETED:
10:35 AM
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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced Case Management visit - Other. Upon arrival LPA met with Administrator Rose Anguiano and explained the reason for the visit.

On 11/14/2023, the Regional Office (RO) received information that this facility will have to be on 24 hour fire watch due to a fire alarm trouble on their fire alarm panel. The Administrator stated Los Angeles Fire Department (LAFD) instructed them to have administrative staff, management, or a caregiver to conduct fire watch every 30 mins until their fire alarm panel is fully functional. Administrator continued to state that only management will be conducting the fire watch patrol. During the visit, LPA contacted LAFD and confirmed these instructions.

 At 9 a.m. LPA toured the physical plant and conducted the fire watch patrol  with Resident Services Coordinator Tina Hernandez. LPA also interviewed staff and reviewed and obtained pertinent documents relevant to the visit.

According to Rose fire alarm devices are still fully operational, but if one device goes into alarm mode the panel can't indicate where the alarm is in the building at this time. Administrator confirmed an appointment with the fire alarm company for Friday to troubleshoot their alarm panel. Administrator was advised of the severity of the situation and to keep LPA updated with the repair process.

LPA did not observe any immediate health and safety concerns during the visit.

Exit interview conducted and a copy of the report was provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2023
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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