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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609532
Report Date: 05/05/2022
Date Signed: 05/05/2022 10:50:45 AM


Document Has Been Signed on 05/05/2022 10:50 AM - 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 HILLSFACILITY NUMBER:
197609532
ADMINISTRATOR:RITA MELDONIANFACILITY TYPE:
740
ADDRESS:9012 TOPANGA CANYON ROADTELEPHONE:
(818) 701-9550
CITY:WEST HILLSSTATE: CAZIP CODE:
91304
CAPACITY:90CENSUS: 56DATE:
05/05/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Ritas MeldonianTIME COMPLETED:
10:58 AM
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At 8:55 a.m. on 05/05/2022 Licensing Program Analyst (LPA) Nicholas Reed conducted an announced case management visit. LPA met with Executive Director (ED) and disclosed the reason for the visit.

During a phone call on 05/04/2022, ED reported concerns to LPA about the health of Resident #1 (R1). R1 and several other residents were recently relocated in the facility due to facility maintenance. Since the move, staff observed weight loss and a pressure injury. R1’s family believes the decline in health was caused by the move, isolation, and lack of care. To address the concerns, LPA conducted a record review and a physical plant tour.

At 9:31 a.m. LPA conducted a record review. LPA reviewed R1’s files and email correspondences. Based on record review, R1 refused facility services for nail filing and certain meals. The facility has offered alternative strategies such as beautician appointments, squeeze pouches, nutritional shakes, and family visits.

At 10:24 a.m. LPA and ED conducted a physical plant tour. LPA visited R1’s room for a health and safety check. R1 was sleeping and on oxygen. The room was sanitary, odorless, and free from hazards. R1 was clean and in good condition. LPA observed a 2 inch scratch on a dresser.

During today's inspection, the facility is in compliance with Title 22 regulations. LPA observed no immediate or potential health, safety, or personal rights risks to residents in care.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:
DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2022
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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