197605820-9-12-2024-29-AS-BBAI-D92UYU-20240912160030

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197605820
Report Date: 09/12/2024
Date Signed: 09/12/2024 04:00:57 PM

Document Has Been Signed on 09/12/2024 04:00 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	SUNRISE OF WESTLAKE VILLAGE		FACILITY NUMBER:	197605820
ADMINISTRATOR:	KENNEDY, EDITH		FACILITY TYPE:	740
ADDRESS:	3101 TOWNSGATE RD		TELEPHONE:	(805) 557-1100
CITY:	WESTLAKE VILLAGE	STATE: CA	ZIP CODE:	91361
CAPACITY:	124	CENSUS: 92	DATE:	09/12/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Edith Kennedy		TIME COMPLETED:	04:30 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 Analysts (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual visit at approx 01:55 p.m. Upon arrival LPA met with Executive Director Edith Kennedy and explained the reason for the visit. staff and explained the reason for the visit. LPA 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. The following was noted: At approx. 02:00 pm, the LPA began the physical plant in the kitchen/food service area. Kitchen was observed to be inaccessible to residents in care. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food properly stored. Refrigerator and food pantry were checked for proper labels and expiration dates. The furniture in the common areas were observed to be in good condition. The facility maintained a comfortable temperature. Smoke detector(s) and carbon monoxide detector were operational at the time of the visit. The fire extinguishers were fully charged and were last serviced 10/03/2023. LPA observed required postings throughout the common space. LPA observed the stairwells and they each had an emergency evacuation chair. Activity Rooms were observed to be clean at the time of visit. At approx 2:15 p.m. LPA observed multiple residents participating in activities in each activity area. Fireplaces were observed adequately screened. LPA observed eight (8) randomly selected resident bedrooms throughout the 3 floors. Each bedroom was observed to be furnished appropriately with linens, appropriate furnishings, and sufficient lighting. The resident restrooms appeared clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared in the private rooms. The hot water measured between 107.9 – 110 degrees Fahrenheit. Continued on 809

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

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 2

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: 09/12/2024

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
26
27
28
29
30
31
32

Continued from 809
The most recent fire alarm and fire sprinkler system inspection was completed on 01/08/2024 and the facility received a passing report for each. LPA observed a sufficient supply of PPE properly stored in the vestibule room. A sufficient supply of Emergency food was observed to be stored in the stairwell room in the staff area located by room #126.

LPA conducted eight (8) interviews during the visit. LPA obtained the following documents - Census, Staff schedule, and Emergency Disaster plan.

Due to time constraints, the annual inspection will be completed on a follow-up visit.

No deficiencies cited at this time. Exit interview conducted and a copy of report was issued to the Executive Director.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2