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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608998
Report Date: 11/02/2022
Date Signed: 11/02/2022 05:49:04 PM


Document Has Been Signed on 11/02/2022 05:49 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: DATE:
11/02/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Susan WeisbarthTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced case management visit due to an incident report that was received by Community Care Licensing. LPA met with administrator and explained the reason for this visit.
An incident report was received on 11/1/22 regarding an incident on 10/25/22 where resident #1 (R1) went on an outing and did not come back to the facility. Facility staff contacted R1's family and R1 was found in Malibu hours later. R1 was returned to the facility. Facility has contacted R1's physician and scheduled appointments on 11/9/22 and 11/10/22 for a new assessment and a new physician report to be filled out. LPA reviewed R1's current physician report and needs and service plan. As of right now R1 is able to leave the facility unassisted. Based on the information obtained through interviews and documentation review no further action is necessary at this time.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell SmithTELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2022
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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