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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603675
Report Date: 02/28/2025
Date Signed: 02/28/2025 02:06:16 PM

Document Has Been Signed on 02/28/2025 02:06 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:GILMAR MANORFACILITY NUMBER:
197603675
ADMINISTRATOR/
DIRECTOR:		VLADIMIR CHERTOKFACILITY TYPE:
735
ADDRESS:15152 VICTORY BLVD.TELEPHONE:
(818) 989-2651
CITY:VAN NUYSSTATE: CAZIP CODE:
91411
CAPACITY: 78CENSUS: 64DATE:
02/28/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:44 AM
MET WITH:Vladimir ChertokTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 10:44 AM. LPA met with facility staff who contacted Director Vladimir Chertok and House Manager Johana Chavez. The Director arrived to the facility at 10:50 AM, entrance interview conducted and the reason for the visit was explained. Beginning at 10:55 AM LPA, Director, and House Manager toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. The following was observed.

BEDROOMS: LPA, facility Director, and facility House Manager toured ten (10) randomly selected bedrooms; five (5) on the first floor and five (5) on the second floor. All rooms observed were properly furnished with sufficient lighting and clean linens and appropriate furnishings. All client bedrooms were observed to be clean and in relatively good repair. All client rooms have been remodeled as of December 2024 with new flooring, paint, new windows, some new/repaired bathroom fixtures, and new air conditioning/heating wall units.

BATHROOMS: All client rooms have an attached private bathroom. Additionally, there are common resident restrooms located throughout the facility. All bathrooms inspected appeared to be clean, properly supplied and in good repair The hot water temperature tested in all bathrooms and was observed to be within the range of 108 - 118.9 degrees Fahrenheit which is in compliance with regulation.

KITCHEN: The kitchen area appeared to be clean and in good repair. All appliances and fixtures appeared to be functional. LPA observed a sufficient supply of two (2) days perishable and seven (7) days non-perishable food stored in the refrigerators and freezers. There were no pesticides (poisons) or toxins stored in any food storage area or preparation area. LPA observed the kitchen to be inaccessible to clients. The hot water temperature was tested the kitchen and was observed to be 118.6 degrees Fahrenheit which is in compliance with regulation. Continued on LIC 809C.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2025
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: 02/28/2025
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COMMON AREAS: This includes the facility’s hallways, three (3) laundry rooms, the television room/dining area, the activity room and entry area. LPA observed all common areas to contain cameras. All common areas were properly furnished and relatively clean. LPA observed renovations to the facility’s hallways to be ongoing at the time of the inspection. LPA observed the hallway to contain a locked food storage closet located on the second floor. This closet contained adequate emergency food supplies. Additionally, LPA observed a locked closet to contain sufficient amounts of extra linens for client use. LPA observed (3) laundry rooms, all were observed to be clean, and fixtures appeared to be functional at the time of the inspection. LPA observed the television room/dining area to contain two (2) vending machines and adequate seating for resident use. LPA observed the activity room to contain books, puzzles, bingo, and other activities for resident use. The entry area was observed to contain a front desk that was manned by facility staff.

STAFF AREAS: This includes the medication/file room, the nurse’s station, and the basement of the facility. LPA observed the medication/file room to be located attached to the front desk and inaccessible to clients in care. LPA observed medications to be properly stored. The nurse’s station was observed to be locked and inaccessible to clients in care. LPA observed the entrance to the basement to be properly secured and located near the kitchen entrance. LPA observed the basement to contain extra PPE supplies, adequate amounts of emergency water, and maintenance tools.

OUTDOOR AREAS: LPA observed a covered parking area attached to the back of the facility. LPA observed a courtyard at the back of the facility leading into the parking area to be equipped with patio furniture appropriate for outdoor use and adequate space for outdoor activities. LPA observed a front patio area at the facility entrance to be equipped with patio furniture appropriate for outdoor use. LPA observed clear passageways to all emergency exits. There were no bodies of water observed on the premise.

RECORD REVIEW: Record review began at 12:45 PM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Five (5) staff files were reviewed. All staff files contained the required documents and trainings. Five (5) resident files were reviewed. All resident files contained all required documentation and signatures. No deficiencies were observed during record review. Continued on LIC 809C.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025
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: 02/28/2025
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INTERVIEWS: During today’s visit LPA interviewed seven (7) clients. All clients interviewed stated that the staff members treat them well and are attentive to their needs. No clients interviewed participated in activities at the facility. No clients interviewed had concerns or recommendations for improvement for the facility. No staff interviews were conducted during today’s visit.

Due to time constraints LPA was unable to complete the annual visit. LPA will return at a later date to conduct a medication audit, interview staff members, and review the facility’s emergency disaster plan and infection control practices. No deficiencies were observed during today’s inspection. The Facility Director had to leave the facility during the inspection but has designated House Manager Johana Chavez to receive and sign this report on their behalf. Exit interview conducted and report issued.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025
LIC809 (FAS) - (06/04)
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