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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608291
Report Date: 06/13/2023
Date Signed: 06/13/2023 04:04:56 PM


Document Has Been Signed on 06/13/2023 04:04 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:BELMONT VILLAGE WESTWOODFACILITY NUMBER:
197608291
ADMINISTRATOR:SCHROEDER, CHRISFACILITY TYPE:
740
ADDRESS:10475 WILSHIRE BLVDTELEPHONE:
(310) 475-7501
CITY:LOS ANGELESSTATE: CAZIP CODE:
90024
CAPACITY:240CENSUS: 181DATE:
06/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:36 AM
MET WITH:ADMINISTRATOR, CHRIS SCHROEDERTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) David España conducted an unannounced Annual visit to Belmont Village Westwood. The purpose of today’s visit was to conduct an unannounced required annual visit. Upon arrival at the facility, LPA conducted a risk assessment at the front desk. LPA verified that the facility has an approved mitigation plan report. LPA was properly screened for Covid-19 symptoms and temperature was checked. LPA met with Executive Director, Chris Schroeder. During the tour, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance. PPE supplies are readily available to staff.

Facility is licensed for 180 non-ambulatory, 60 bedridden and a hospice waiver for 20. Facility is approved for delayed egress. The facility currently has 181 residents and 7 residents on hospice. The facility does not handle any of the residents’ money. LPA toured the physical plant, toured a vacate unit and reviewed medication. The facility consists of 176 units of which 31 of those units have 2 bedrooms and 2 bathrooms. All other units have one bed and one bathroom. Facility also has a lobby area, 3 dining rooms and a bistro, kitchen, salon, theater, gym, several recreational spaces and patios. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew. The water temperature in vacant room measured within range. Common areas were clean and clear of hazards; doorways were free of obstructions. All exit doors in the memory care unit have auditory alarms.



Due to running out of time LPA must return to complete Annual visit to Belmont Village Westwood.
Exit interview was held. A copy of the report was provided to Executive Director, Chris Schroeder.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2023
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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