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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603296
Report Date: 11/09/2022
Date Signed: 11/09/2022 06:55:49 PM


Document Has Been Signed on 11/09/2022 06:55 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: 105DATE:
11/09/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:45 PM
MET WITH:Elvis GuitierrezTIME COMPLETED:
07:00 PM
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At 4:45 p.m. on 11/09/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an announced case management visit. LPA met with Administrator and disclosed the reason for the visit.

LPA conducted today’s case management visit after the Woodland Hills-South Regional Office received an elder abuse report alleging the sexual abuse of Resident #1 (R1) by Resident #2 (R2).

LPA met with and interviewed R1 from 4:45 p.m. to 6:30 p.m. R1 had 3 family members join the meeting virtually through Zoom. LPA interviewed the Administrator at 6:30 p.m.

LPA will discuss evidence with licensing program management and report back to all parties with updates.

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: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2022
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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