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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608998
Report Date: 09/08/2022
Date Signed: 09/08/2022 02:18:42 PM


Document Has Been Signed on 09/08/2022 02:18 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., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:CANYON TRAILS AT TOPANGA SENIOR LIVINGFACILITY NUMBER:
197608998
ADMINISTRATOR:SUSAN WEISBARTHFACILITY TYPE:
740
ADDRESS:7945 TOPANGA CANYON BLVDTELEPHONE:
(818) 716-9900
CITY:CANOGA PARKSTATE: CAZIP CODE:
91304
CAPACITY:120CENSUS: 89DATE:
09/08/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Susan WeisbarthTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted a case management pertaining to an special incident report (SIR) received to the RO, from the facility reporting that the facility having A/C issues. LPA met with Executive Director (ED) Susan Wesibarth, who was informed the reason of the visit. LPA also met and spoke with the maintenance director Erasmo Rodriguez. LPA conducted a physical plant and inspected rooms on the first and second floor of the building, including the Memory Care unit.

According to the ED, about a month ago, there was a power outage and the A/C went down for a few hours and had to be reset. In recent events, on 09/02/2022, the A/C went out on the assisted living (AL) side on the second floor. The facility fixed the issue and it was repaired. For precautionary measures, the facility purchased fans for residents and requested a repairman to check the system and provide an estimate to install or repair the system. As of today's visit, the Administrator is still waiting for the estimate and has contacted another company which will come out on Saturday 09/10/2022 to provide details on what is needed to either repair or replace the system. The Administrator will submit estimate documents, as well as a plan of correction for the A/C to Licensing on Monday 09/12/2022.

During the physical plant inspection, LPA checked several rooms on the first and second floor; including the Memory Care unit. Rooms were in compliance, according to Licensing regulations. The Administrator will report to Licensing regarding the plan to continue to fix the A/C. At this time, no further action is required, unless the system is not in working conditions or not in compliance.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2022
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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