197600430-10-12-2023-29-AS-EPEI-CWJTUE-20231012150209

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197600430
Report Date: 10/12/2023
Date Signed: 10/12/2023 03:03:21 PM

Document Has Been Signed on 10/12/2023 03:03 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	VALLEY VIEW RETIREMENT CENTER		FACILITY NUMBER:	197600430
ADMINISTRATOR:	JUDITH MONTOYA		FACILITY TYPE:	740
ADDRESS:	7720 WOODMAN AVE.		TELEPHONE:	(818) 997-6756
CITY:	PANORAMA CITY	STATE: CA	ZIP CODE:	91402
CAPACITY:	116	CENSUS: 69	DATE:	10/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Judith Montoya, Administrator		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 Analysts (LPA) Emily Peraldi and Brian Balisi arrived at the facility unannounced to conduct a required annual visit. At 10:15 a.m., the LPAs met with the Administrator and explained the reason for the visit. At 10:42 a.m., the LPAs along with the Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. KITCHEN: The LPAs observed the kitchen/dining area. Knives are stored in the inaccessible kitchen. Kitchen appliances appear to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 10:52 a.m., hot water measured at 117.1-degree Fahrenheit. BEDROOMS: The LPAs observed nine (9) resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. Between 10:48 a.m. and 11:30 a.m., hot water measured between 105.4 and 117.1-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. OUTDOOR SPACE: At 10:53 a.m., the LPAs observed the back and front of the facility which has a covered outdoor area for resident use. There is a gate on the side of the facility designated for an emergency exit. There are no bodies of water on the premises. The facility only has a parking lot, no garage nor basement. Continued on LIC 809-C.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VALLEY VIEW RETIREMENT CENTER	FACILITY NUMBER: 197600430
	VISIT DATE: 10/12/2023

NARRATIVE

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COMMON AREAS: The LPAs observed common area to be relatively clean and properly furnished. The LPAs observed the fire extinguisher to be fully charged and last serviced on 10/05/2023. Signs are posted throughout facility to promote handwashing, and cough/sneeze etiquette. Fire alarm, fire sprinklers and fire doors were observed and passed by the Fire Department. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the janitor closets and storage. Medications and first aid kits are located in a locked medication room. Laundry units and additional linens are located inside laundry room.

RECORD REVIEW: Starting at 11:30 a.m., the LPA conducted a file review for all residents and staff. Staff records were reviewed for documents including, but not limited to health screening, TB test, staff training records, and fingerprint clearance. All files were in order. The Administrator’s Certificate expires 01/31/2024. The LPA reviewed resident records for nine (9) out of sixty-nine (69) residents. Resident’s records were reviewed for, but not limited to care plans, medical records, admissions agreement, and consent forms. All files were in order. Additionally, the LPAs received a copy of valid liability insurance and Facility Disaster Emergency Plan.

Between 11:19 a.m. and 11:46 a.m., the LPA conducted interviews with six (6) staff and eight (8) residents.

Between 1:50 p.m. and 2:15 p.m., the LPA conducted a review of medication and medication documentation with Medication Technician for six (6) residents and observed all medications were properly documented and assisted with as prescribed.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily Peraldi	TELEPHONE: 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

LIC809 (FAS) - (06/04)

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