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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609641
Report Date: 05/13/2021
Date Signed: 05/13/2021 11:49:55 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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:COMMONS AT WOODLAND HILLS, THEFACILITY NUMBER:
197609641
ADMINISTRATOR:STEWART, BRADLEYFACILITY TYPE:
740
ADDRESS:21711 VENTURA BLVDTELEPHONE:
(818) 999-2610
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91364
CAPACITY:200CENSUS: 98DATE:
05/13/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Hana Meyers TIME COMPLETED:
12:00 PM
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Licensing Program Analysts (LPA's) Brian Balisi and Zabel Chochian conducted an unannounced Required Annual inspection. LPAs met with Assistant Executive Director Hannah Meyers and explained the reason for the visit.

Between 9:30am - 12:00pm, LPA conducted physical plant with Meyers. LPAs also conducted interviews with resident and some staff.

Between 9:30am - 12:00pm, LPAs did not observe a sufficient amount of the following: Signs that are posted throughout facility to promote hand washing , cough / sneeze etiquette, and physical distancing and signs that are posted throughout facility to encourage residents to report acute respiratory illness to staff.

Hannah also informed LPAs that not all staff have been fit tested for N95 respirators.

LPAs advised Hannah to post additional signs throughout the facility and LPAs will provide Hannah with information and resources to have all staff fit tested for N95 respirators.

Exit interview conducted with Hannah Meyers, report issued and sent via E-mail.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian BalisiTELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021
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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