<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197609532
Report Date:
06/23/2021
Date Signed:
06/23/2021 10:55:52 AM
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:
SUNRISE ASSISTED LIVING OF WEST HILLS
FACILITY NUMBER:
197609532
ADMINISTRATOR:
RITA MELDONIAN
FACILITY TYPE:
740
ADDRESS:
9012 TOPANGA CANYON ROAD
TELEPHONE:
(818) 701-9550
CITY:
WEST HILLS
STATE:
CA
ZIP CODE:
91304
CAPACITY:
90
CENSUS:
56
DATE:
06/23/2021
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
09:30 AM
MET WITH:
Rita Meldonian
TIME COMPLETED:
10:30 AM
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 Analyst (LPA) Wendell Smith conducted an unannounced case management visit. The purpose of this visit was to go over the recent Decision and Order which grants a conditional exemption to staff # 1(S1) for a period of two years. LPA confirmed with administrator that S1 is not working at the facility. LPA met with the administrator and went over the Decision and Order.
LPA also took a physical plant tour of the facility and did not observe any health and safety issues. Exit Interview conducted.
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/23/2021
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
1