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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603296
Report Date: 06/02/2022
Date Signed: 06/02/2022 04:44:45 PM


Document Has Been Signed on 06/02/2022 04:44 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: 107DATE:
06/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:14 PM
MET WITH:Elvis GutierrezTIME COMPLETED:
04:52 PM
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At 2:14 p.m. on 06/02/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with Administrator and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out. The facility was last visited on 11/11/2020 for a complaint visit. It is a two story community with 115 apartments, living room, dining room, mail room, library, activity rooms, card room, beauty salon, 2 gyms, laundry rooms, medication room, business offices, 2 courtyards, parking lots, and outdoor areas. It has an approved fire clearance for 130 nonambulatory residents. Approved hospice waivers for 7. The facility uses a ceiling sprinkler system throughout.

Entry: LPA observed 3 residents sitting in a shaded area at the front. The facility displayed postings for its masking requirement, handwashing requirement, COVID-19 precautions, confidential complaints, and notice of a recent positive case in the community. Hand sanitizer was available. LPA observed a binder with the CDSS Provider Information Notices (PINs).

Screening: At approximately 2:25 p.m. LPA observed staff screening a visitor for temperature and symptoms. LPA was also screened for symptoms of infectious disease. The screening station contained a screening computer, digital thermometer, symptom questionnaire, and hand sanitizer.

Bedrooms: The facility has 115 apartments. Apartments range from studios to two bedroom apartments. All bedrooms contained a chair, nightstand, lamp, storage, emergency call systems, and bed with adequate bedding. All furnishings were clean and in good condition. At 3:45 p.m. Administrator and LPA tested the smoke detector in a vacant unit. LPA heard smoke detectors throughout the unit function at the same time. The front desk and maintenance teams were alerted via walkie talkie.

Bathrooms: Bathrooms contained liquid soap, paper towels, trash cans, grab bars near the toilet and shower, and emergency call systems. At 2:43 p.m. LPA measured the water temperature in the All Gender Bathroom near the lobby to be 116.8 degrees Fahrenheit.

SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2022
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: 06/02/2022
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Medication Room: LPA and Administrator spoke with a med tech in the medication room. The med tech confirmed the room is locked when no staff are present. All medications were locked. The facility uses the ElderMark system for medication management.

Kitchen: LPA observed an adequate supply of perishable and non-perishable food. At 3:52 p.m. LPA observed a monthly temperature log for refrigerator temperatures. All readings were 38 degrees Fahrenheit or below. Hoods were clean and free of debris. Appliances were functional. All surfaces were sanitary. The facility uses disposable utensils and tableware for COVID-positive residents.

Laundry: 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.

Common Areas: Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. The facility had television, video games, puzzles, and board games in the first floor common areas. From approximately 2:30 p.m. to 3:30 p.m. LPA observed a piano player in the main lobby playing for residents. Residents were also observed playing Mahjong. At 4:02 p.m. LPA measured the room temperature to be 73 degrees Fahrenheit. Mail Area: 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.

Safety: All emergency exit paths were free from obstructions. At 2:41 p.m. LPA observed fully charged fire extinguishers near the lobby and upstairs. They were last inspected on 06/21/21. At 2:52 p.m. Administrator provided the most recent fire inspection. On 04/27/22 Fire Fox fire safety inspected all fire doors and alarms and found no defects. At 2:55 p.m. Administrator provided the most recent fire clearance inspection by LAFD on 02/28/2022. The report showed all systems passed inspection. During today’s inspection, 3 residents were in quarantine. Due to the positive cases, Administrator described the updated COVID-19 policies which included resident mask wearing during coffee hour, exercise classes relocated outside, disposable tableware used, and all staff wearing KN95 masks.

Outdoor areas: LPA observed the southern courtyard to be free of debris and tripping hazards. Three residents were sitting in the shade.

During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022
LIC809 (FAS) - (06/04)
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