197603296-6-15-2022-31-AS-NRED-CFEW5Y-20220615165954

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197603296
Report Date: 06/15/2022
Date Signed: 06/15/2022 05:00:34 PM

Document Has Been Signed on 06/15/2022 05:00 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 HILLS		FACILITY NUMBER:	197603296
ADMINISTRATOR:	ELVIS GUTIERREZ		FACILITY TYPE:	740
ADDRESS:	8138 WOODLAKE AVE		TELEPHONE:	(818) 713-0900
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91304
CAPACITY:	130	CENSUS: 106	DATE:	06/15/2022
TYPE OF VISIT:	Case Management - COVID-19	ANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Elvis Gutierrez		TIME COMPLETED:	02:50 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	At 1:35 p.m. on 06/15/2022 Licensing Program Analyst (LPA) Nicholas Reed and LACDPH nurse Brenna DeLeon conducted a Technical Advisory visit. LPA and RN met with Executive Director Elvis Gutierrez and Head of Wellness Daniel. LPA, RN, ED, and HoW toured the facility inside and out. 19 positive residents have reported positive between 06/01/2022 and 06/12/2022. 3 staff (2 wellness team, 1 housekeeper) have reported positive. 4 residents have been hospitalized. 2 residents have returned from West Hills Medical Center. 2 residents remain at Northridge Hospital. Symptomatic residents have reported fatigue, headaches, body aches, and sore throat. 103 out of 106 residents have received their first booster. 3 refuse to get the booster. The facility has fully followed COVID guidelines. All residents are isolated in their private rooms (Red zones). Those residents are monitored once per shift, 3 times per day at a minimum. At night, staff check the residents every 2 hours. Each isolation room has appropriate signage, PPE stations with masks, sanitizer, wipes, PPE, and trash bags, and trash cans with tight fitting lids inside the rooms for PPE disposal. Meals and medications are delivered by designated Wellness team staff. Specific Wellness team staff are 1:1 with the red zone residents. Disposable cutlery and utensils are used. The facility is conducting facility-wide testing for all residents today and all staff tomorrow, 06/16/2022. Entry: The facility has 2 signs noting the current outbreak. Hand sanitizer is available. Clorox wipes and EPA approved cleaners were recently purchased. The check-in system is computerized. Symptom questionnaire screens for close contacts and symptoms. RN DeLeon noted that during a surge, vaccination status is irrelevant. Visitors who want indoor visitation MUST provide proof of a negative test, either PCR, antigen, or rapid.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022

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: 06/15/2022

NARRATIVE

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Kitchen: Handwashing signs were observed. All staff wore N95 masks. The staff break room is located behind the kitchen. All staff cohort together in the staff area. RN DeLeon noted the Wellness team members who work 1:1 with the Red Zone residents must take their breaks elsewhere to avoid infecting other staff members.

Laundry: A vacant apartment on the second floor is designated for Red Zone resident laundry. All laundry is double bagged, sealed tightly, and transported to the apartment. All loads are individual.

Gyms: The facility has 2 gyms on the first floor. Both gyms had postings for the masking requirement and sanitization requirement. ED confirmed the rooms are sanitized before and after each use.

Elevators: The facility has 2 elevators. Both elevators had postings for the social distancing policy: 2 person
maximum.

Common Areas: Each room has its own air conditioning. Hallways and common areas also have common air conditioning. RN DeLeon advised the facility switch the A/Cs from “auto” to “on” for maximum circulation. Red Zone residents have designated balconies for isolation breaks and fresh air. Mask wearing has been reinstated for common areas.

At 3:00 p.m. on 06/14/2022 ED Elvis Gutierrez emailed the following list of COVID positive residents.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022

LIC809 (FAS) - (06/04)

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