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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603296
Report Date: 09/14/2024
Date Signed: 09/14/2024 03:24:34 PM


Document Has Been Signed on 09/14/2024 03:24 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., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:FAIRWINDS - WEST HILLSFACILITY NUMBER:
197603296
ADMINISTRATOR:ELVIS GUTIERREZFACILITY TYPE:
740
ADDRESS:8138 WOODLAKE AVETELEPHONE:
(818) 713-0900
CITY:WEST HILLSSTATE: CAZIP CODE:
91304
CAPACITY:130CENSUS: 112DATE:
09/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:11 AM
MET WITH:Elvis GutierrezTIME COMPLETED:
03:30 PM
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Licensing Program Analysts (LPAs) Gary Tan and Michael Cava conducted an Annual Required visit and inspection of the facility. LPAs met with the administrator, Elvis Gutierrez and advised him of the visit.

At approximately 9:30am, with the assistance of the administrator, LPAs took a tour of the physical plant. The facility is a two story building. There are five stairwells. An evacuation chair is stationed at each stairwell.

Kitchen: LPAs observed an adequate supply of perishable and non-perishable food. There is a monthly temperature log for refrigerator temperatures. Kitchen appliances were clean, free of debris and functional. All surfaces were sanitary.

Bedrooms: The facility has 115 apartments. Apartments range from studios to two bedroom apartments. All bedrooms contained a chair, night stand, lamp, storage, emergency call systems, and bed with adequate bedding. All furnishings were clean and in good condition. Smoke detectors and emergency call systems in random units were tested, and are functional. Communication within staff throughout the building is made through walkie talkie.

Bathrooms: Bathrooms were checked for proper fixtures, grab bars, appropriate hygiene items and emergency call systems. LPAs measured the water temperature in the public bathrooms and the bathrooms in resident rooms to be 120 degrees Fahrenheit.

Common Areas: Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. The facility common areas have television/monitors, variety of seating, tables and chairs. There is a private dining room on the first floor, located by the elevator. Dinning area has multiple tables enough to seat the capacity
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2024
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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: FAIRWINDS - WEST HILLS
FACILITY NUMBER: 197603296
VISIT DATE: 09/14/2024
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of 130. Resident mailboxes are located near the front lobby. Near the mailboxes hung postings for resident rights, rights of resident councils, personal property procedures, ombudsman contacts, and a suggestion box.

Surrounding Grounds: All emergency exit paths were free from obstructions. LPAs observed fully charged fire extinguishers all throughout the facility. They were last charged on 07/25/24. The most recent fire inspection was made by LAFD on 08/13/24 and 08/14/24. Fire doors, sprinklers and alarms were found with no defects. The report showed all systems passed inspection. The last fire drill was conducted by the facility on 08/29/24.

Outdoor areas: LPAs observed the southern courtyard to be free of debris and tripping hazards. There was furniture appropriate for outdoor use.


Laundry area: Appliances in the laundry room were operational. The laundry room was sanitary. All detergents were locked. The laundry room was locked with a numeric keypad.

Resident Files: LPAs conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPAs also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

Medications: Medication room is locked when no staff are present. All medications were locked inside the medication room. Medication and Medication Records were reviewed for proper storage and documentation.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of this Report Issued.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2024
LIC809 (FAS) - (06/04)
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