197605820-8-25-2022-29-AS-ASMH-CHMNJ5-20220825102947

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197605820
Report Date: 08/25/2022
Date Signed: 08/25/2022 10:30:18 AM

Document Has Been Signed on 08/25/2022 10:30 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	SUNRISE OF WESTLAKE VILLAGE		FACILITY NUMBER:	197605820
ADMINISTRATOR:	HOWELL, ZACHARY		FACILITY TYPE:	740
ADDRESS:	3101 TOWNSGATE RD		TELEPHONE:	(805) 557-1100
CITY:	WESTLAKE VILLAGE	STATE: CA	ZIP CODE:	91361
CAPACITY:	124	CENSUS: 79	DATE:	08/25/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Zak Howell		TIME COMPLETED:	10:45 AM

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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to conduct a required annual visit, which has an emphasis on infection control practices and procedures. This visit was conducted in conjunction with the local and state health department. In attendance included Deborah Leonard from Ventura County Public Health, and Cherish Mendoza and Shantala Ahanya from the California Department of Public Health. All parties met with Executive Director Zak Howell and explained the reason for the visit.

All parties toured the physical plant areas inside and outside to ensure there are no health and safety hazards and community is in compliance with Title 22 Regulations.

Common Areas: Common areas were observed to be clean and in good condition. There were no obstructions and/or tripping hazards throughout the facility. Exits with doors were inspected. The facility maintains a comfortable temperature at 75 degrees Fahrenheit. Planned activities are offered, but at this time there are no group activities. Activity schedule is posted throughout the community. There are fire extinguishers throughout the community, which were charged and last serviced October 2021. The smoke detectors are hard-wired in the common areas and were last tested December 2021. The sprinkler system is tested quarterly.

Kitchen: The facility had a sufficient supply of two-day perishable and seven-day nonperishable food at the time of the visit. The facility uses Sysco Foods for food delivery. The menu was posted, and the facility offers an alternate menu. Due to a current COVID-19 positives within the facility, dining is suspended. Staff are delivering meals to the resident’s rooms, and regularly providing snacks and hydration to the residents.

Restrooms: Common restrooms were observed, and the LPA observed signs in the restrooms that promoted good hand hygiene. Restrooms were fully stocked with paper towels and soap.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 VILLAGE	FACILITY NUMBER: 197605820
	VISIT DATE: 08/25/2022

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Exterior Grounds: The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. Parking is available for residents and visitors.

Infection Control: Throughout the visit, the LPA observed signs in common areas that promoted guidance around COVID-19, appropriate masking, physical distancing, and the disinfection protocol. In addition, the LPA observed hand sanitizer interspersed throughout the common grounds. The community continues to monitor the vitals, symptomatic screening, and temperatures of the staff and visitors that come into the community. Staff are up to date regarding guidelines pertaining to visitation and vaccine requirements.

During today's visit, discussion was had regarding testing, symptom screening, and adjusted procedures around visitation. The cleaning and disinfectant protocol is adequate; however, staff were reminded to observe the contact time needed for surfaces to be properly disinfected. The community is not experiencing any issues with staffing or obtaining Personal Protection Equipment (PPE) at this time. Isolation carts were observed outside the rooms in which there is a confirmed positive case. It was recommended to provide additional staff training pertaining to donning, doffing, and appropriate disinfecting practices.

The facility has previously managed COVID-19 active cases and the facility complied with all requirements set forth by the local health department and licensing. The Infection Control plan and required updates were submitted timely. The community's policies and procedures as it pertains to infection control are adequate.

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

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022

LIC809 (FAS) - (06/04)

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