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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608908
Report Date: 09/29/2021
Date Signed: 09/29/2021 04:29:40 PM

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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:MONTECEDROFACILITY NUMBER:
197608908
ADMINISTRATOR:DAVID WEIDERTFACILITY TYPE:
741
ADDRESS:2212 EL MOLINOTELEPHONE:
(626) 788-4900
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY:300CENSUS: 181DATE:
09/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:David Weidert, AdministratorTIME COMPLETED:
04:30 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 Analysts (LPAs) Rosaura Valenzuela and LaQueena Lacy conducted an unannounced Required 1-year infection control inspection to the facility.

LPAs met with the Executive Director David Weidert and Director of Resident Health Services Kris Hillary. The purpose of the visit was discussed.

At 10:45am, with the assistance of the ED and Director of Resident Health Care Services, LPAs conducted a tour of the facility inside and out.

There are two entrances being utilized at the facility, there are required poster posted at the main door. Screening area is located immediately upon entrance. Electronic sign in, hand sanitizer, and masks are available. LPAs were screened upon entry.

The facility had submitted and approved Mitigation Plan.

Signs to wear a mask and other COVID-19 prevention protocol signs were posted outside the door. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated visitors' area in the front of the building. The facility has sufficient stock of PPE in the storage room.

See 809-C to continue
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura ValenzuelaTELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
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
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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: MONTECEDRO
FACILITY NUMBER: 197608908
VISIT DATE: 09/29/2021
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
26
27
28
29
30
31
32
The facility consists of 4 main buildings. The Independent Living section of the CCRC includes floors 1 through 4 of the "Main" building and 3 separate multi story Villa's named Marsten, Green and Hunt.

The independent living units have their own laundry, kitchen, bathrooms, living rooms and dining area. There is a separate beauty saloon on first floor. There is a swimming pool and a spa, both of which are completely fenced with 5 foot high fencing. The gates are locked. The independent residents are given key cards for access. There are two restaurants, Theater, Exercise room, Art Studio, Library, Card Room, multiple activity spaces and a Bar available to the independent residents. There is a fountain located at the Independent living entrance that is gated with large stones that will only allow 3 inches of water on the surface.

The facility maintains a comfortable temperature at 78 degrees. The smoke detectors are hardwired and interconnected and observed to be operational. There are carbon monoxide detectors in the facility. Fire extinguishers are located throughout the facility and were last serviced in June of 2021.

The bathrooms were checked for cleanliness and proper operation. LPAs observed the appropriate grab bars in the showers and toilets. The hot water temperature was measured at 111.5 degrees F and at 108.8 degrees F in the memory care unit.

Medications-LPAs observed medication cart in the wellness center to be locked and inaccessible to residents. There were two ( 2) complete first aid kits.

Exit interview conducted. A copy of this report was issued and signature obtained.
No deficiencies were issued at this time
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura ValenzuelaTELEPHONE: (818) 421-5360
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2