197608467-7-7-2024-31-AS-RCOR-D6XNG6-20240707102636

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608467
Report Date: 07/05/2024
Date Signed: 07/07/2024 10:27:37 AM

Document Has Been Signed on 07/07/2024 10:27 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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	BELMONT VILLAGE HOLLYWOOD		FACILITY NUMBER:	197608467
ADMINISTRATOR:	JANELLE TOPETE		FACILITY TYPE:	740
ADDRESS:	2051 N HIGHLAND AVE		TELEPHONE:	(323) 874-7711
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90068
CAPACITY:	150	CENSUS: 89	DATE:	07/05/2024
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Nathaniel Akyempon		TIME COMPLETED:	03:30 PM

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Licensing Program Analyst, (LPA) Raymond Comer, made an unannounced site visit to this facility as a continuation of the Required 1 Year Annual Inspection conducted on 07/01/2024. LPA met with Director, Nathaniel Akyempon, and the purpose of visit was disclosed.

The following remaining inspection domains were observed, reviewed and inspected:

Fire Safety: Fire Detection/Protection system is present in the facility. LPA observed multiple smoke and carbon monoxide alarms installed, hardwired, and interconnected. Fire system back up and tests are completed and documented on a monthly basis. Fire Alarm System was tested and working properly. Fire drill last conducted 6/12/2024. Fire extinguishers were observed on all floors of the Facility. All extinguishers were last serviced on 2/08/2024. Roof access is inaccessible to residents. Evacuation routes are clearly labelled and posted throughout the facility. LPA observed evacuation chairs in all stairwells of the facility.

Kitchen: At 1:30 PM, LPA observed kitchen to be clean, with an adequate supply of perishable and non-perishable foods located in the refrigerator, freezer, and pantry. LPA observed a variety of fresh fruits, vegetables, meats, dry cereals, and desserts. Foods are properly labeled and stored. Knives and sharps are stored in a designated area of the kitchen. Kitchen is secured and inaccessible to residents.

Medications: Medication Room is located on the third floor. Medication room is secured and inaccessible to residents. Medications are listed on a centrally stored medication and destruction record log. First Aid kits are complete.

[Continued on LIC 809C]

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) -596-4373
LICENSING EVALUATOR NAME: Raymond Comer	TELEPHONE: 818-401-8655
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2024

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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BELMONT VILLAGE HOLLYWOOD	FACILITY NUMBER: 197608467
	VISIT DATE: 07/05/2024

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Laundry: At 2:00 pm. LPA observed laundry rooms located on each floor. Residents have access to do their own laundry. Laundry area is clean and clear from obstruction. Cleaning supplies, and other toxins, are securely stored and inaccessible to residents.

Commons: LPA inspected activity rooms, movie theater, salon, wellness centers, gym, library, dining rooms and reception areas. Common areas were observed to be clean with adequate furnishings for resident use. Furnishings are in good condition. No obstructions, nor tripping hazards observed.

Bedrooms: LPA observed resident bedrooms and bathrooms on all four (4) floors for safety, privacy, and comfort. Bedrooms were inspected and observed to maintain required furnishings and sufficient lighting, bed linens, and blankets. All bedrooms were observed to be clean and clear of obstructions.

Bathrooms were observed to be clean and sanitary with necessary supplies and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured at 118.0°F. Within the required range.

Outdoor: Courtyard area observed to have a shaded patio, with tables with sufficient seating for the residents. Outdoor furniture observed to be in good condition. All trash cans were observed to be covered. There are no bodies of water in the facility.

There were no immediate health and safety hazards observed at the time of this inspection. Exit interview conducted and a copy of this report was given to facility Staff Director, Nathaniel Akyempon.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) -596-4373
LICENSING EVALUATOR NAME: Raymond Comer	TELEPHONE: 818-401-8655
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2024

LIC809 (FAS) - (06/04)

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