<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608381
Report Date: 07/18/2024
Date Signed: 07/18/2024 04:48:49 PM


Document Has Been Signed on 07/18/2024 04:48 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 S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:BE WELL SENIOR LIVING II INC.FACILITY NUMBER:
197608381
ADMINISTRATOR:MELNIKOV, RUSLANFACILITY TYPE:
740
ADDRESS:5711 BECKFORD AVENUETELEPHONE:
(818) 578-5839
CITY:TARZANASTATE: CAZIP CODE:
91356
CAPACITY:6CENSUS: 5DATE:
07/18/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ruslan MelnikovTIME COMPLETED:
04:45 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
At 10:30 a.m. on 07/18/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced case management visit. LPA met with staff and later the licensee and disclosed the reason for the visit.

Today's case management visit was conducted due to a deficiency discovered during the course of investigating complaints #31-AS-20240717143523 and 31-AS-20240718083724. During a physical plant tour at approximately 10:40 a.m. today, the toilet tank in the north bathroom was observed to be exposed and without a lid. LPA also observed this during the annual inspection on 03/22/2024 and provided a note of technical assistance. At approximately 11:15 a.m., the licensee stated that the part was ordered but never installed. Based on observations and interviews, the facility bathroom was in disrepair. A deficiency is cited on the corresponding LIC 809-D page.

No immediate health and safety risks were observed during today’s visit.

Exit interview conducted. Appeal rights discussed. Copy of report provided.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:
DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2024
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


Document Has Been Signed on 07/18/2024 04:48 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/29/2024
Section Cited
CCR
87303(e)(6)

1
2
3
4
5
6
7
87303 Maintenance and Operation
(e) ...plumbing fixtures shall be maintained as follows: (6) Toilet, handwashing and bathing facilities shall be maintained in operating condition.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee has agreed to install the toilet fixture by the POC due date and send a photograph of the repair.
8
9
10
11
12
13
14
Based on observation and interview, the licensee did not comply with the section cited above in one (01) bathroom toilet which poses a potential Health, Safety, or Personal Rights risk to residents in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:
DATE: 07/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2