<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197605820
Report Date: 07/13/2021
Date Signed: 07/13/2021 11:55:30 AM

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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:SUNRISE OF WESTLAKE VILLAGEFACILITY NUMBER:
197605820
ADMINISTRATOR:HOWELL, ZACHARYFACILITY TYPE:
740
ADDRESS:3101 TOWNSGATE RDTELEPHONE:
(805) 557-1100
CITY:WESTLAKE VILLAGESTATE: CAZIP CODE:
91361
CAPACITY:124CENSUS: 63DATE:
07/13/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Becky Buck and Zak HowellTIME COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Ashley Smith arrived at 10:30 a.m. for an unannounced Case Management visit to the facility today in response to an incident communicated to the Department on July 8, 2021. The LPA met with Becky Buck and Zak Howell and explained the reason for the visit.

On July 8, 2021, the LPA received a call from Executive Director Zak Howell regarding an incident involving Resident #1 (R1). At that time, the LPA requested and received pertinent documents from the Executive Director. During today's visit, the LPA interviewed staff at 10:37 a.m. and 11:41 a.m., and spoke with Resident #1 (R1) at 11:10 a.m.

Further investigation is required at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1