197605820-10-13-2023-29-AS-TCAA-CWKUEE-20231013153102

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197605820
Report Date: 10/13/2023
Date Signed: 10/13/2023 03:31:58 PM

Document Has Been Signed on 10/13/2023 03:31 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:	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: 85	DATE:	10/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Zachary Howell		TIME COMPLETED:	03:45 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 (LPAs) Teresa Camara and Martha Arroyo arrived at the facility unannounced to conduct a required annual visit at 9:10 a.m. Upon arrival LPAs met with Executive Director Zak Howell and explained the reason for the visit. Entrance interview conducted. At 10:15 a.m., the LPAs along with the Executive Director, 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. DINING ROOM / KITCHEN: The LPAs toured the kitchen / food service area at 12:20 p.m., The kitchen appeared clean and the appliances and fixtures functional. Refrigerated and frozen foods were stored at proper temperature. There was a sufficient amount of perishable and non-perishable food in the kitchen properly stored. Food labels were inspected and checked for dates and expiration dates. At 12:25 p.m., the LPA observed perishable items in poor condition as they had passed their expiration dates. These items included: three (3) containers of yogurt and one (1) container of egg whites. Items were discarded at the time of the visit. Residents do not have access to the kitchen, dangerous items are stored inaccessible to residents. The facility menu appears to meet the daily dietary needs of residents. There were no pesticides or poisons observed near any food areas. COMMON AREAS: LPAs inspected the common areas throughout the building. The common areas were observed to be properly furnished and relatively clean at the time of the visit. Fireplaces were observed to have adequate screens at the time of the visit. LPAs observed sanitizer readily available in areas with high touch surfaces. Furniture was observed to be in good condition in each common area. The facility maintained a comfortable temperature. Carbon monoxide detectors were operational at the time of the visit. The smoke (continued on 809C; page 2)

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

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: SUNRISE OF WESTLAKE VILLAGE	FACILITY NUMBER: 197605820
	VISIT DATE: 10/13/2023

NARRATIVE

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(continued from 809; page 1)

detectors and fire suppression system was last serviced on 8/4/2023. Fire extinguishers were observed throughout the facility, fully charged, and last serviced on 10/03/2023. An adequate supply of emergency food and water was observed. The LPAs observed required postings throughout the common spaces. Entry/exits were free of obstruction. The outdoor areas were clean and free of hazards. The patios and balconies have proper furnishings.

BEDROOMS / BATHROOMS: The LPAs inspected ten (10) randomly selected bedrooms throughout the three (3) floors. The resident bedrooms were properly furnished with a bed, nightstand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPAs observed all bathrooms in each resident bedroom were clean, properly supplied and had functional fixtures. The hot water was measured in each bathroom within 105 - 120 degrees Fahrenheit. Resident bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels.

RECORDS: Records review began at 12:45 p.m., five (5) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. All files were in order at this time.

Five (5) Personnel records and current Executive Director files were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order.

Fire and earthquake drills were conducted within the last 6 months as per regulation; the last one conducted 10/03/2023.

MEDICATIONS: Medications review began at approximately 1:30pm. The medications are centrally stored and inaccessible to residents in care. Medication carts were observed on each floor locked and inaccessible at the time of the visit. No medication errors observed at this time.

(continued on 809C; page 3)

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: SUNRISE OF WESTLAKE VILLAGE	FACILITY NUMBER: 197605820
	VISIT DATE: 10/13/2023

NARRATIVE

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(continued from 809C; page 2)

INFECTION CONTROL: Upon entry, there is a central entry point for symptom screening, temperature checks, and sanitation station. At this time, the staff will continue to keep up signs that promote good hand hygiene and symptoms of communicable diseases. The facility has 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 single isolation room if the facility has a confirmed case of a communicable disease. The facility’s policies and procedures as it pertains to infection control are adequate at this time.

Between 10:50 a.m. and 2:20 p.m., the LPAs interviewed five (5) residents and five (5) staff members.

During today’s visit, the LPAs obtained copies of the following: staff schedule, resident roster, Emergency Disaster Plan, and current liability insurance.

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

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

LIC809 (FAS) - (06/04)

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