197609532-2-24-2022-31-AS-NRED-CBY335-20220224165259

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609532
Report Date: 02/24/2022
Date Signed: 02/24/2022 04:53:51 PM

Document Has Been Signed on 02/24/2022 04:53 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:	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:	02/24/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Rita Meldonian		TIME COMPLETED:	05:00 PM

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At approximately 3:15 PM on 02/24/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection using the infection control domain of the Compliance and Regulatory Enforcement (CARE) tools. LPA met with Executive Director and disclosed the reason for the visit.

Census: 56

The facility was separated into Assisted Living and Memory Care wings. It was two stories tall, had a kitchen, dining room, 3 laundry rooms, 2 activity rooms, outdoor space, and storage areas.

Entry: The one main entrance was locked from the outside and unlocked from the inside. LPA observed signs posted on the front door regarding the facility’s visitation policy, vaccination requirement, and masking requirement. LPA observed other postings inside regarding personal rights, resident councils, grievance procedures, Ombudsman phone number, and an activity schedule.

Screening: LPA was screened upon entry for temperature and symptoms of COVID-19. LPA observed a mounted digital thermometer, hand sanitizer, a handwashing station, a visitor log, and a symptom screening questionnaire.

LPA and Director conducted a physical plant tour at approximately 3:30 PM

Bedroom: LPA observed bedrooms which were clean, odorless, and free from debris. All furniture, walls, ceilings, and window screens were in good repair.

Bathroom: All public bathrooms and resident bathrooms were fully stocked with liquid soap, paper towels, trash cans with tight fitting lids, and handwashing instruction signs. Resident bathrooms also contained toilets and bathtubs with grab bars and non-skid surfaces.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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
	VISIT DATE: 02/24/2022

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Safety: LPA observed fire sprinklers, hard-wired smoke detectors, and carbon monoxide detectors in all bedrooms and throughout the facility. LPA observed fire extinguishers in the dining room and in hallways with flashlights in cases. All fire extinguishers were fully charged and were checked on a monthly basis. The most recent extinguisher inspection date was 02/10/2022. The memory care unit used doors on all exits with 15 second delayed egress. All emergency exit paths were free from obstructions and unlocked. LPA observed all carpeted floors to be free from frays or tripping hazards. Stairs had safety strips on the top and bottom levels.

Kitchen: LPA observed a clean and sanitary kitchen area. Staff showed LPA a cleaning log for the kitchen which documented cleaning practices after breakfast, lunch, and dinner. Food was covered and all surfaces were clean.

Dining Area: LPA observed a menu near the Dining Room. Dining tables were at least 6 feet apart. The facility provided a separate table for unvaccinated residents.

Laundry: LPA observed 3 locked laundry rooms with functional washers and dryers inside. LPA also observed a locked janitorial closet with cleaning solutions inside.

Common Areas: The facility had signs throughout pertaining to its COVID-19 policies including social distancing, cough etiquette, symptoms, and hygiene practices. The facility’s elevator had signs for social distancing and a 2 person maximum.

LPA conducted exit interview and issued report.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2022

LIC809 (FAS) - (06/04)

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