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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609532
Report Date: 11/09/2021
Date Signed: 11/10/2021 07:38:35 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 HILLSFACILITY NUMBER:
197609532
ADMINISTRATOR:RITA MELDONIANFACILITY TYPE:
740
ADDRESS:9012 TOPANGA CANYON ROADTELEPHONE:
(818) 701-9550
CITY:WEST HILLSSTATE: CAZIP CODE:
91304
CAPACITY:90CENSUS: 57DATE:
11/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Liza BondTIME COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA) Eleza Jackson conducted an unannounced annual required visit. Upon entry to the facility LPA's temperature was checked and a covid screening was completed. LPA Jackson met with the Resident Care Director, Liza Bond; explained the reason for this visit, and confirmed that a Mitigation Plan had been submitted to the department. LPA Jackson began a physical plant tour with Resident Care Director, Liza Bond at approximately 12:15pm. The facility is a two-story building with resident rooms containing private bathrooms, multiple public bathrooms, several staff offices, several common areas, a dining room, kitchen and indoor activity space. The facility is divided into Assisted Living and Memory Care sections. LPA Jackson toured a random selection of residents bedrooms. All bedrooms were properly furnished and had appropriate bed linens, and bathrooms in each of the resident rooms. The bistro, dining areas, TV room, and common areas were clean and had appropriate furniture. Medications were locked in medical carts stored at designated areas of the facility. Appropriate furniture for outdoor use was observed with no visible hazards. All pathways appeared clear of obstruction. Smoke and carbon monoxide detectors were observed to be working properly. All required postings were observed to be posted throughout the facility. No deficiencies cited.
Exit Interview conducted.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Eleza JacksonTELEPHONE: (661) 361-6007
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
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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