197608381-3-22-2024-31-AS-NRED-D3LQ5R-20240322115222

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608381
Report Date: 03/22/2024
Date Signed: 03/22/2024 11:52:59 AM

Document Has Been Signed on 03/22/2024 11:52 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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	BE WELL SENIOR LIVING II INC.		FACILITY NUMBER:	197608381
ADMINISTRATOR:	MELNIKOV, RUSLAN		FACILITY TYPE:	740
ADDRESS:	5711 BECKFORD AVENUE		TELEPHONE:	(818) 578-5839
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	6	CENSUS: 6	DATE:	03/22/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Ruslan Melnikov and Elina Root		TIME COMPLETED:	12:00 PM

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At 8:30 a.m. on 03/22/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and later the licensee and co-administrator and disclosed the reason for the visit.

The facility was last visited on 03/18/2022 for an annual visit. It is a single story building with seven (07) bedrooms, two (02) bathrooms, kitchen, office, common areas, and outdoor areas. It has an approved fire clearance for six (06) nonambulatory residents, of which one (01) may be bedridden. The facility serves residents with dementia. Approved hospice waivers for four (04).

LPA and staff toured the facility inside and out at 8:40 a.m.

The front entrance was gated and unlocked. The front yard was maintained. Once inside, LPA observed postings near the main entrance for Ombudsman contacts, confidential complaint contacts, facility license, COID precautions and procedures, emergency disaster plan, facility sketch, personal rights, rights of resident councils, and emergency contacts. A screening station at the front contained a visitor log, gloves, masks, and sanitizer.

Walls, floors, windows, screens, and blinds were clean and in good repair. At 8:50 a.m. LPA measured the room temperature to be seventy (70) degrees Fahrenheit. Surveillance cameras were observed at the main entrance and a hallway. The living rooms contained televisions, reading material, activities, exercise equipment, and karaoke equipment. A fireplace was appropriately grated with the gas line turned off. Medications were locked near the dining room. The house phone was tested to be operational at 9:00 a.m.

At 9:05 a.m., LPA tested the carbon monoxide detector above the dining room to be operational. Two (02) other carbon monoxide detectors were observed in the facility.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024

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 S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BE WELL SENIOR LIVING II INC.	FACILITY NUMBER: 197608381
	VISIT DATE: 03/22/2024

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LPA observed an adequate supply of perishable and non-perishable foods in the kitchen. The stove hood was clean. Appliances were in good condition. Sharps were locked below the counter top. At 9:10 a.m. the refrigerator and freezer temperatures were measured to be forty (40) and zero (00) degrees Fahrenheit, respectively. Cleaning solutions were locked in a laundry room adjacent to the kitchen. Also located in the laundry room were a washer and dryer. Both were in working order. At 9:15 a.m. LPA observed a fully charged fire extinguisher in the kitchen. It was last inspected on 04/15/2023.

The facility has seven (07) bedrooms. 1 bedroom is designated as an office. The office was locked and free of hazards. Bedroom #5 was designated for storage and was free of hazards. All bedrooms contained a chair, lamp, nightstand, storage, and a bed with adequate bedding. All furnishings were clean and in good condition. Bedrooms with oxygen in use contained appropriate signage.

The facility has 2 bathrooms. All bathrooms contained liquid soap, paper towels, handwashing instruction sign, trash cans with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower.

LPA observed a shaded patio area in the rear of the facility. The patio contained furniture in good condition. The back yard was maintained with fruit trees and shrubs.

Two (02) out of two (02) emergency exit paths were free from obstructions. Two (02) out of two (02) auditory alarms were turned on and functioning. At approximately 11:30 a.m. the smoke detector in the hallway was tested and operational. At approximately 11:45 a.m. LPA measured the water temperature to be 111.5 degrees Fahrenheit.

LPA reviewed resident medications at 9:20 a.m., staff and resident files at 10:40 a.m., and conducted staff and resident interviews at 11:15 a.m.

During today's inspection, the facility was in compliance with Title 22 regulations. No immediate health and safety risks were observed during this visit.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024

LIC809 (FAS) - (06/04)

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