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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608998
Report Date: 02/27/2025
Date Signed: 02/27/2025 12:33:44 PM

Document Has Been Signed on 02/27/2025 12:33 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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:CANYON TRAILS AT TOPANGA SENIOR LIVINGFACILITY NUMBER:
197608998
ADMINISTRATOR/
DIRECTOR:		SUSAN WEISBARTHFACILITY TYPE:
740
ADDRESS:7945 TOPANGA CANYON BLVDTELEPHONE:
(818) 716-9900
CITY:CANOGA PARKSTATE: CAZIP CODE:
91304
CAPACITY: 120CENSUS: 90DATE:
02/27/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Ivan Saa - Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
12:50 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
On 2/27/25 Licensing Program Analysts (LPAs) Perchui Milena Khurshudyan and Angela Panushkina, conducted an unannounced CASE MANAGEMENT visit at this facility to issue deficiency in conjunction with complaint control # 31-AS-20241106150126. LPAs met with facility Executive Director (ED) and explained the reason for the visit.
LPAs conducted a physical plant walk through, at approximately 9:20am, to ensure that the facility is in compliance under Title 22 California Code of Regulations. At 9:50am, LPAs requested staff and resident rosters.
During the initial complaint visit on 11/7/2024, LPA Khurshudyan conducted interviews and records review and informed that on 11/3/2024 around 1:30am R1 attempted to awol from the Memory Care unit and tried to exit the egress door to Assisted Living area. S1 and S2 (nights shift caregiver and MedTech) attempted to redirect R1 back to Memory Care unit, however, R1 got aggressive and while kicking S1’s left knee lost their balance and hit their face on the door. First aid was provided right away and with the help of S1 and S2 R1 went to their room. The following day on 11/4/2024 around midnight R1 had another episode of aggressive behavior and another attempt to awol from the Memory Care unit. Despite several attempts of redirecting R1 to their room, R1 opened the back exit egress door and was able to go outside and fell on the concrete. LPA conducted tour and observed that the egress door did properly work, however, when the alarm went off the facility did not have sufficient night shift caregivers on the floor to prevent the incident happening. R1 was transported to the hospital for further evaluation. Lastly, LPAs were informed that the Memory Care Unit had total of fifty-five (55) residents, two (2) of which had wandering behaviors. Also, two (2) staff members were scheduled for the night shift to cover 1st and 2nd floors by providing care and supervision. During interviews ED and Memory Care director confirmed that R1 had wondering behavior and numerous episodes of incidents got recorded of R1 being agitated towards staff and other residents in care and the incident happened due to failing to respond to egress door alarm in a timely manner.

Deficiencies are cited and noted on LIC 809D. Exit interview conducted. Appeal rights explained. Copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2025
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
Document Has Been Signed on 02/27/2025 12:33 PM - It Cannot Be Edited


Created By: Perchui Khurshudyan On 02/27/2025 at 11:25 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CANYON TRAILS AT TOPANGA SENIOR LIVING
FACILITY NUMBER: 197608998

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2025
Section Cited
CCR
87705(e)(7)

1
2
3
4
5
6
7
Care of Persons with Dementia:
(e) Licensees that use delayed egress devices on exterior doors… shall meet the following initial and continuing requirements: (7) Delayed egress devices shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents…
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Executive Director informed LPAs that the facility is actively looking to hire more staff. Copy of LIC500, reflecting new hired staff along with their required/completed training will be submitted to LPA by POC date.
8
9
10
11
12
13
14
Based on interviews and records review the licensee did not comply with the section cited above by not ensuring the staff responded to egress door alarm in a timely manner, resulting in injuries and hospitalization of R1. This posed a potential health, safety or personal rights risk to residents in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Nichelle Gillyard
LICENSING EVALUATOR NAME:Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2025


LIC809 (FAS) - (06/04)
Page: 2 of 2