197608478-9-30-2022-29-AS-BBAI-CJRRNN-20220930131038

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608478
Report Date: 09/30/2022
Date Signed: 09/30/2022 01:14:32 PM

Document Has Been Signed on 09/30/2022 01:14 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 HILLS		FACILITY NUMBER:	197608478
ADMINISTRATOR:	BENITO DEL TORO		FACILITY TYPE:	740
ADDRESS:	20461 VENTURA BLVD		TELEPHONE:	(818) 346-9046
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91364
CAPACITY:	127	CENSUS: 66	DATE:	09/30/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Patrice O' Grady - Executive Director		TIME COMPLETED:	01:30 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	Licensing Program Analyst (LPA) Brian Balisi arrived to this facility today to conduct a One (1) year Required inspection of this facility with emphasis on infection control practices and procedures. LPA met with Patrice O' Grady - Executive Director and explained the reason for the visit. The facility is fire cleared for one hundred twenty seven (127) non-ambulatory residents, of which fifteen (15) may be bedridden and has hospice waiver for fifteen (15) residents. LPA conducted physical plant tour of the facility with Patrice. Randomly selected residents' bedrooms on the first, second, third and fourth floors were inspected. Common areas, including the activity rooms, TV room, dining rooms, piano hall and sun room/library appeared clean and were properly furnished. Fire extinguishers throughout the facility were observed fully charged and last serviced in October 2021. The kitchen appeared clean and the appliances and fixtures functional. Refrigerated and frozen foods were stored at proper temperature. There was a sufficient amount of perishable and non-perishable food at the facility and properly stored. Residents do not have access to the kitchen, dangerous items are stored inaccessible to residents. The facility menu appears to meet the daily dietary needs for residents. There were no pesticides or poisons observed near any food areas. Entry/exits were free of obstruction. The outdoor areas were clean and free of hazards. The patios and balconies have proper furnishings. The medications were observed locked in medication carts located on each floor. Continued on 809-C

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 HILLS	FACILITY NUMBER: 197608478
	VISIT DATE: 09/30/2022

NARRATIVE

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Continued from 809

Personal accommodations in resident bedrooms and bathrooms were observed for safety, privacy, and comfort. Random resident rooms were inspected and observed with all required furnishings and grab bars and nonskid surfaces in the bathrooms. Hot water temperature in random resident bathrooms were checked and measured within the required range of 105 - 120 degrees Fahrenheit.

There were storage room and storage areas located in the basement parking garage. Storage areas were observed to store emergency food supplies, extra medical supplies and medical equipment. No obstructions or hazardous items to residents in care were observed in the parking garage at this time. A sufficient supply of PPE was observed in storage on the 4th floor.

The LPA spoke with Patrice regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate each resident who test positive to isolate in their private room or to use the fourth floor with single isolation rooms if the facility has an outbreak. COVID-19 testing is conducted weekly if anyone shows any symptoms. The facility’s policies and procedures as it pertains to infection control are adequate at this time.

No deficiencies cited. Exit interview conducted. A copy of the report was issued

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

LIC809 (FAS) - (06/04)

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