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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603675
Report Date: 03/14/2024
Date Signed: 03/15/2024 08:43:54 AM

Document Has Been Signed on 03/15/2024 08:43 AM - 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:GILMAR MANORFACILITY NUMBER:
197603675
ADMINISTRATOR:VLADIMIR CHERTOKFACILITY TYPE:
735
ADDRESS:15152 VICTORY BLVD.TELEPHONE:
(818) 989-2651
CITY:VAN NUYSSTATE: CAZIP CODE:
91411
CAPACITY: 78CENSUS: 59DATE:
03/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Johana ChavezTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Teresa Camara arrived at the facility unannounced to conduct a required annual inspection. Upon arrival LPA met with House Manager Johana Chavez and explained the reason for the visit. LPA toured the physical plant areas to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. Fire extinguishers throughout the facility were observed to be fully charged and last serviced April 10, 2023.

KITCHEN: The kitchen appeared clean and the appliances and fixtures functional. LPA found a sufficient amount of perishable food stored in the refrigerators and freezers and a sufficient amount of non-perishable food stored in the kitchen and a separate locked food storage closet on the second floor. The facility keeps emergency supplies of water on the second floor and in the basement. There were no pesticides (poisons) or toxins stored in any food storage area or preparation area. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen was inaccessible to clients.
BEDROOMS:  LPA inspected ten (10) randomly selected bedrooms; seven (7) on the second floor and three (3) on the first floor. All rooms were shared rooms. The rooms were properly furnished with sufficient lighting and clean linens. Rooms and common areas were being cleaned during LPA's visit. There were six (6) rooms unoccupied on the second floor that were being remodeled with new flooring, paint, new windows, some new/repaired bathroom fixtures, and new air conditioning/heating wall units. Clients vacated their rooms during the remodel and will be moving back into their rooms upon completion.
BATHROOMS: Each client room also has a bathroom. All bathrooms inspected  appeared to be clean, properly supplied and had functional fixtures. The hot water temperature tested in the bathrooms was observed to be within the range of 115.4 - 117.4 degrees Fahrenheit.

(continued on LIC809-C)
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2024
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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: GILMAR MANOR
FACILITY NUMBER: 197603675
VISIT DATE: 03/14/2024
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(continued from LIC809)

COMMON AREAS:  LPA observed the dining areas and activity room. The common areas were properly furnished and relatively clean. There were two (2) vending machines located in the television room/dining area. There was a basement located near the kitchen entrance. LPA observed this area to store extra PPE supplies, building materials as well as the electrical storage closet.  LPA observed (3) laundry rooms (2) on the second floor and (1) on the first floor. There was a laundry room on the second floor designated for clients use but staff do laundry for clients. LPA observed laundry rooms to be clean and fixtures appeared to be functional at this time. Emergency/disaster and PPE supplies are properly stored in several areas easily accessible to staff.

SURROUNDING GROUNDS: The covered parking area is attached to the facility. The building is currently undergoing mandated earthquake retrofitting so the parking area is closed. There were no hazardous items observed to be left out by the construction crew. LPA observed the courtyard leading into the parking area equipped with patio furniture appropriate for outdoor use and plenty of room for outdoor activities. There is also a front patio at facility entrance equipped with patio furniture appropriate for outdoor use as well. LPA did not observe any obstructions to emergency exits at this time. There were no bodies of water on the premise.

INTERVIEWS: LPA interviewed four (4) clients and four (4) staff; no concerns noted.

INFECTION CONTROL: LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a vacant unit as the single isolation room if the facility has a confirmed case of COVID-19. The facility does not have a confirmed case of COVID-19 at this time; however, the facility’s policies and procedures as it pertains to infection control are adequate at this time.

LPA will return at a later date to finalize the annual inspection. No citations issued.

Exit interview conducted and report issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024
LIC809 (FAS) - (06/04)
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