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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608478
Report Date: 03/22/2022
Date Signed: 03/22/2022 01:25:07 PM


Document Has Been Signed on 03/22/2022 01:25 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:SUNRISE ASSISTED LIVING OF WOODLAND HILLSFACILITY NUMBER:
197608478
ADMINISTRATOR:BENITO DEL TOROFACILITY TYPE:
740
ADDRESS:20461 VENTURA BLVDTELEPHONE:
(818) 346-9046
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91364
CAPACITY:127CENSUS: 73DATE:
03/22/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:28 PM
MET WITH:Benito Del Toro - Executive Director TIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced Case Management - Incident visit. Upon arrival LPA met with Executive Director Benito Del Toro and explained the reason for the visit.

On 3/15/2022, the Regional Office received a SOC 341 regarding an incident that had allegedly occurred to Resident 1 (R1). ON 3/15/2022 at approximately 3:45pm, R1 reported to staff that Staff 1 (S1), inappropriately touched R1 while R1 was sitting in their living room in their private room. R1 does not remember the day or time, but stated to staff the incident occurred approximately a week before they reported it to staff.

At approx 12:30pm, LPA conducted physical plant, interviewed staff as well as reviewed and obtained pertinent documents relevant to the investigation. LPA did not observe any immediate or potential health and safety concerns at this time.

The LPA has determined further investigation is needed and will return at a later date to complete the investigation if warranted.

Exit interview conducted. Report issued and sent via email.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian BalisiTELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2022
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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