197608694-3-13-2024-29-AS-VCOY-D3BVMC-20240313163319

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608694
Report Date: 03/13/2024
Date Signed: 03/13/2024 04:33:25 PM

Document Has Been Signed on 03/13/2024 04:33 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	VILLAGE AT SHERMAN OAKS, THE		FACILITY NUMBER:	197608694
ADMINISTRATOR:	GRACE HARTNETT		FACILITY TYPE:	740
ADDRESS:	5450 VESPER AVE		TELEPHONE:	(818) 994-7900
CITY:	SHERMAN OAKS	STATE: CA	ZIP CODE:	91411
CAPACITY:	179	CENSUS: 150	DATE:	03/13/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Grace Hartnett		TIME COMPLETED:	05:00 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 Analysts (LPAs) Valeria Conway and Teresa Camara arrived at the facility to conduct a One (1) year Required inspection. LPAs met with Executive Director (ED), Grace Hartnett at 10:05 a.m. and at 10:30 a.m. Mariana Pelayo (Regional Nurse) arrived at the facility and joined the visit. LPAs explained the reason for the visit. At 11:45 a.m. LPAs, ED and RN conducted a physical plan tour of the facility to ensure there are no health and safety hazards. The building has several floors divided into separate areas of licensed and independent living occupants. The facility is licensed in Building A on the 1st, 2nd and 3rd floor. There were no obstructions and/or tripping hazards throughout the facility. The facility maintains a comfortable temperature at 72 degrees. In Building B, only the 2nd floor is licensed. Fire extinguishers were observed throughout the facility and appeared to be fully charged and last serviced in October 2023. The facility’s fire suppression system was last checked by Johnson Controls North America on 2/22/2024 and passed. The elevators and emergency power generator was last checked on 9/2/2023 by Absolute Fire Protection, Inc. and passed. Smog detector and carbon monoxide detectors were checked in all resident’s room on 12/27/2023 and passed. Resident Rooms: From 12:12 p.m. until approximately 2:08 p.m., LPAs inspected (10) randomly selected apartments. The resident rooms were properly furnished with, at minimum, a bed, nightstand, chairs, and sufficient lighting for each resident. The rooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPAs observed all bathrooms in each resident room were clean, properly supplied and had functional fixtures. LPAs observed all resident bathrooms to have grab bars, and non-slip materials in showers. The hot water was measured in each bathroom between 106.2 – 120 degrees Fahrenheit. Continued on 809-C

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria Conway	TELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024

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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: VILLAGE AT SHERMAN OAKS, THE	FACILITY NUMBER: 197608694
	VISIT DATE: 03/13/2024

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Continued from LIC 809

Common Areas: Between 11:55 a.m.- 2:07 p.m., LPAs inspected the common areas throughout the facility. These included two (2) dining areas, activity rooms, (2) libraries, sitting area, theater, fitness areas, café, patios, and inner courtyard. The common areas were observed to be properly furnished and relatively clean at this time. At approximately 1:45 p.m., LPAs observed multiple residents playing cards in the 1st floor activity area. LPA observed appropriate posters and information about resident’s rights.

Kitchen: The kitchen was observed to be only accessible to staff. The kitchen appeared to be clean, and the appliances and fixtures appeared to be in operable condition during the time of visit. LPAs observed enough perishable and non-perishable food at the facility; properly stored. LPAs observed emergency food supply to be sufficient at this time. Dining furniture in dining room area appeared to be clean and sufficient at this time. Staff lounge located off the rear hallway near the kitchen.

Memory Care: LPAs inspected (3) randomly chosen rooms during the physical plant tour. The resident rooms were observed to be properly furnished with a bed, nightstand, and sufficient lighting for each resident. The rooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Each room had a private bathroom. LPAs observed each bathroom to be clean, properly supplied and had functional fixtures. LPAs observed all resident bathrooms to have grab bars, non-slip material in showers and locked cabinets. LPAs observed an alarm sound off upon opening the exit door and staff responded immediately.

Outdoor Area: There were shaded areas throughout the exterior of the facility with sufficient room for activities. LPAs observed sufficient furniture designated for outdoor use. There is a pool located on the facility located on the independent living side of the facility. LPAs observed gate to the pool to be closed and locked at this time. Parking Garage was accessible from the exterior. Cleaning supplies were located in a storage closet on the far wall near the exit of the garage. There was a fountain located in the courtyard entrance.

Interviews: LPAs conducted interviews with seven (7) residents; no concerns noted. LPAs conducted interviews with six (6) staff; no concerns noted.

LPAs will return at a later date to conclude the annual inspection. Exit interview conducted and report issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria Conway	TELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024

LIC809 (FAS) - (06/04)

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