197603437-8-27-2024-29-AS-EMOY-D8JUFP-20240827153303

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197603437
Report Date: 08/27/2024
Date Signed: 08/27/2024 03:33:11 PM

Document Has Been Signed on 08/27/2024 03:33 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:	LEISURE LIVING INC.		FACILITY NUMBER:	197603437
ADMINISTRATOR:	PARVIN HASHEMI		FACILITY TYPE:	740
ADDRESS:	30821 CATARINA DR.		TELEPHONE:	(818) 879-9988
CITY:	WESTLAKE VILLAGE	STATE: CA	ZIP CODE:	91362
CAPACITY:	6	CENSUS: 6	DATE:	08/27/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Michelle Hashemi		TIME COMPLETED:	03:40 PM

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Licensing Program Analyst (LPA) Erica Mosley arrived at the facility unannounced to conduct a required annual visit at 9:45 a.m. The LPA was greeted by staff and informed them of the reason for the visit. Administrator Michelle Maurer was contacted and arrived shortly after.

The LPA and staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

BEDROOMS/BATHROOMS: The LPA began the inspection with the bedrooms and bathrooms at 9:45 a.m. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are six (6) designated resident rooms and one (1) staff room. There was a linen closet in the hallway with extra towels and linens. The resident bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature measured between 111.2 and 111.3 degrees Fahrenheit between 10:15 and 10:40 a.m.

KITCHEN: The LPA continued the inspection in the kitchen/food service area at 10:15 a.m. Knives and cleaning supplies are stored inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food.

COMMON AREAS: At the time of the visit, living room and dining room furniture were observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature of 77 degrees. Smoke detector(s) and carbon monoxide detector were tested at 10:33 a.m. and operational at the time of the visit. The fire extinguisher was fully charged and was last serviced September 21, 2023. The LPA observed required postings throughout the common space.

Continued on LIC 809-C

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Erica Mosley	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024

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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LEISURE LIVING INC.	FACILITY NUMBER: 197603437
	VISIT DATE: 08/27/2024

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OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for client use. There is a side gate for emergency exit use and is single latched. No bodies of water noted and exits are free of obstructions at the time of visit. The garage is where the washer and dryer are held. Cleaning supplies and disinfectants are kept in locked in the garage. The LPA observed additional non-perishable food supply, emergency water and food.

RECORDS: Residents’ records review began at 10:37 a.m., records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order.

Personnel records review began at 11:50 a.m. were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. Emergency drills are conducted monthly with the last one conducted on 08/01/2024 of both fire and earthquake. First aid kit and supplies are sufficiently stocked.

The LPA obtained the following documents:

- LIC500 Personnel Report
- LIC9020 Client Roster
- Liability Insurance
- LIC 610E Emergency and disaster plan

MEDICATIONS: Medications review began at 2:45 p.m.; medications are centrally stored and locked in a closet at the entrance of the facility. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review.

INTERVIEWS: Three (3) staff interviews were conducted with all staff demonstrating knowledge of their responsibilities and duties. Three (3) out of six (6) residents were interviewed and no concerns were noted at the time of the visit.

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

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Erica Mosley	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 08/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024

LIC809 (FAS) - (06/04)

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