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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197609700
Report Date:
11/12/2024
Date Signed:
11/13/2024 09:04:10 AM
Document Has Been Signed on
11/13/2024 09:04 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
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER:
197609700
ADMINISTRATOR/
DIRECTOR:
DAVTYAN, ANNA
FACILITY TYPE:
740
ADDRESS:
16246 VINTAGE ST
TELEPHONE:
(747) 529-4964
CITY:
NORTH HILLS
STATE:
CA
ZIP CODE:
91343
CAPACITY:
6
TOTAL ENROLLED CHILDREN:
0
CENSUS:
5
DATE:
11/12/2024
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:
Anna Davytan- Licensee
TIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an annual required visit and inspection of the facility. LPA met with staff Alice Keshishian and was explained the reason for the visit. At 1:11 PM Anna Davtyan who is the administrator met with LPA, explained the reason for the visit.
At 1:10 PM, with the assistance of staff and administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are operational that are located each bedroom, the hallway and kitchen. There are carbon monoxide detectors that functions properly. The fire extinguisher is in the kitchen. The charge date is 10/31/2024. During the visit the facility is at 75 degrees Fahrenheit. The facility is fire cleared for six (06) non-ambulatory residents; one (1) bedridden. Facility has five (5) hospice waiver. Facility has no issue with fire clearance.
Kitchen:
The kitchen appliances and fixtures were functional. The kitchen has a working gas stove, faucet, freezer, refrigerator, and microwave. LPA found enough at least two (2) days perishable and seven (7) days non-perishable food at the facility that is properly stored. Frozen foods are wrap, dated, and stored properly as well. Knives were stored in a locked cabinet in the kitchen. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and locked away in the kitchen .
Bedrooms:
There were five (5) bedrooms designated for residents' use. Bedroom #1, bedroom #2, bedroom #3, and bedroom #5 are all private, Bedroom #4 is shared. All of the bedrooms are used by residents were properly furnished with appropriate dresser, beddings, and linens with sufficient lighting.
Continue to LIC 809-C
Nichelle Gillyard
TELEPHONE:
(818) 596-4370
Leslie Ngo-Castaneda
TELEPHONE:
(818) 214-9900
DATE:
11/12/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/12/2024
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
22
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER:
197609700
VISIT DATE:
11/12/2024
NARRATIVE
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Bathrooms:
There are two (2) bathroom designated for residents' use. The bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 105.8 degrees Fahrenheit for bathroom #1 located in the hallway across bedroom #3. Bathroom #2 is inside bedroom #5. Hot water temperature was measured at 106.8 degrees Fahrenheit. There was enough clean linen available in the cabinets in the hallway.
Common Areas:
LPA toured all common areas of the facility. These included the living room and dining area for residents. The common areas were properly furnished. Residents dining table fits enough for six (6). LPA observed common areas to be very clean and tidy. LPA observed the floors to be in very good condition. No obstructions and or tripping hazards throughout the facility. Furniture in common area was observed to be in good repair.
Infection control
: Facility mitigation plan to make sure licensee was following current infection control recommendations. LPA obtain a copy and reviewed the infection control plan during this visit.
Surrounding Grounds
: Entry and exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The facility does not have a swimming pool or body of water. There is no garage in the facility, only car ports.
Laundry service:
There is enough linen available to change weekly or more if need. Cleaning supplies are being stored in a locked cabinet in the kitchen area and is located in between the dining room and kitchen.
Staff Files
: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms. Office space is beside the dining area. Records were checked for expired or missing certificates and clearances: LPA conducted a file review of staff for criminal record clearances and current First Aid. The administrator file was reviewed for current first aid, fingerprint clearance, administrator certificate, and HIV/AIDS and TB training. Staff #3 (S3) is missing training, deficiency will be cited on LIC 809-D.
Continue to LIC 809-C
SUPERVISOR'S NAME:
Nichelle Gillyard
TELEPHONE:
(818) 596-4370
LICENSING EVALUATOR NAME:
Leslie Ngo-Castaneda
TELEPHONE:
(818) 214-9900
LICENSING EVALUATOR SIGNATURE:
DATE:
11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/12/2024
LIC809
(FAS) - (06/04)
Page:
2
of
22
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER:
197609700
VISIT DATE:
11/12/2024
NARRATIVE
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Medications
are in a centrally stored and locked place, including over-the-counter medicines; medications are properly labeled and checked for expiration dates. Each centrally stored prescription and PRN medication has been logged in the medications log with proper documentation from the clients’ doctor. Proper medication dispensing instruction are followed and checked for contamination. First-aid has all proper items and is current.
Resident records
were reviewed for requirements and legibility: LPA reviewed client’s files for current appraisals. Liability insurance copy was handed to LPA. Planned activities are offered. R2, R4 and R5 is missing TB test, deficiency will be cited on LIC 809-D.
Facility is within CA code of Regulations Title 22 or Health and Safety Code. No deficiencies were found, exit interview conducted, copy of report has been issued and discussed.
SUPERVISOR'S NAME:
Nichelle Gillyard
TELEPHONE:
(818) 596-4370
LICENSING EVALUATOR NAME:
Leslie Ngo-Castaneda
TELEPHONE:
(818) 214-9900
LICENSING EVALUATOR SIGNATURE:
DATE:
11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/12/2024
LIC809
(FAS) - (06/04)
Page:
3
of
22
Document Has Been Signed on
11/13/2024 09:04 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER:
197609700
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Administrator Certification Requirements
(a) All individuals shall be residential care facility for the elderly certificate holders prior to being employed as an administrator. (1) Applicants who possess a valid Nursing Home Administrator license, issued by the California Department of Public Health, shall be exempt from completing an approved Initial Certification Training Program and taking a written exam, provided the individual completes twelve (12) hours of classroom instruction in the following Core of Knowledge areas: (A) Four (4) hours of instruction in laws, regulations, policies, and procedural standards that impact the operations of residential care facilities for the elderly, including but not limited to the authority referenced in this Chapter.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
TELEPHONE:
(818) 596-4370
Leslie Ngo-Castaneda
TELEPHONE:
(818) 214-9900
DATE:
11/12/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/12/2024
LIC809
(FAS) - (06/04)
Page:
4
of
22
Document Has Been Signed on
11/13/2024 09:04 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER:
197609700
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Administrator Certification Requirements
(a) All individuals shall be residential care facility for the elderly certificate holders prior to being employed as an administrator. (1) Applicants who possess a valid Nursing Home Administrator license, issued by the California Department of Public Health, shall be exempt from completing an approved Initial Certification Training Program and taking a written exam, provided the individual completes twelve (12) hours of classroom instruction in the following Core of Knowledge areas: (B) Four (4) hours of instruction in medication management, including the use, misuse, and interaction of drugs commonly used by the elderly, including antipsychotics, and the adverse effects of psychotropic drugs for use in controlling the behavior of persons with dementia.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
TELEPHONE:
(818) 596-4370
Leslie Ngo-Castaneda
TELEPHONE:
(818) 214-9900
DATE:
11/12/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/12/2024
LIC809
(FAS) - (06/04)
Page:
5
of
22
Document Has Been Signed on
11/13/2024 09:04 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER:
197609700
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Administrator Certification Requirements
(a) All individuals shall be residential care facility for the elderly certificate holders prior to being employed as an administrator. (1) Applicants who possess a valid Nursing Home Administrator license, issued by the California Department of Public Health, shall be exempt from completing an approved Initial Certification Training Program and taking a written exam, provided the individual completes twelve (12) hours of classroom instruction in the following Core of Knowledge areas: (C) Four (4) hours of instruction in resident admission, retention, and assessment procedures.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Section Cited
Personnel Requirements - General
(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance:
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
TELEPHONE:
(818) 596-4370
Leslie Ngo-Castaneda
TELEPHONE:
(818) 214-9900
DATE:
11/12/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/12/2024
LIC809
(FAS) - (06/04)
Page:
6
of
22
Document Has Been Signed on
11/13/2024 09:04 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER:
197609700
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Personnel Records
(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. (2) Documentation of staff training shall include: (A) Trainer's full name;
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Section Cited
Personnel Records
(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. (2) Documentation of staff training shall include: (B) Subject(s) covered in the training;
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
TELEPHONE:
(818) 596-4370
Leslie Ngo-Castaneda
TELEPHONE:
(818) 214-9900
DATE:
11/12/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/12/2024
LIC809
(FAS) - (06/04)
Page:
7
of
22
Document Has Been Signed on
11/13/2024 09:04 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER:
197609700
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Personnel Records
(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. (2) Documentation of staff training shall include: (C) Date(s) of attendance; and
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Section Cited
Personnel Records
(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. (2) Documentation of staff training shall include: (D) Number of training hours per subject.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
TELEPHONE:
(818) 596-4370
Leslie Ngo-Castaneda
TELEPHONE:
(818) 214-9900
DATE:
11/12/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/12/2024
LIC809
(FAS) - (06/04)
Page:
8
of
22
Document Has Been Signed on
11/13/2024 09:04 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER:
197609700
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Personnel Records
(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. (2) Documentation of staff training shall include: (D) Number of training hours per subject. 1. If the training is provided by a trainer in a classroom setting, documentation shall consist of notices of course completion signed by the trainer.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Section Cited
Personnel Records
(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. (2) Documentation of staff training shall include: (D) Number of training hours per subject. 2. If the educational hours/units are obtained through an accredited educational institution, documentation shall include a copy of a transcript or official grade slip showing a passing mark.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
TELEPHONE:
(818) 596-4370
Leslie Ngo-Castaneda
TELEPHONE:
(818) 214-9900
DATE:
11/12/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/12/2024
LIC809
(FAS) - (06/04)
Page:
9
of
22
Document Has Been Signed on
11/13/2024 09:04 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER:
197609700
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Personnel Records
(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. (2) Documentation of staff training shall include: (D) Number of training hours per subject. 3. If the educational hours/units are obtained through continuing education, documentation shall include a transcript or official grade slip showing a passing mark, if applicable, or a Certificate of Completion.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Section Cited
General Requirements for Restricted Health Conditions
(2) Ensure that facility staff who will participate in meeting the resident's specialized care needs complete training provided by a licensed professional sufficient to meet those needs.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
TELEPHONE:
(818) 596-4370
Leslie Ngo-Castaneda
TELEPHONE:
(818) 214-9900
DATE:
11/12/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/12/2024
LIC809
(FAS) - (06/04)
Page:
10
of
22
Document Has Been Signed on
11/13/2024 09:04 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER:
197609700
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
General Requirements for Restricted Health Conditions
(2) Ensure that facility staff who will participate in meeting the resident's specialized care needs complete training provided by a licensed professional sufficient to meet those needs. (B) Training shall be completed prior to the staff providing services to the resident.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Section Cited
Other Provisions
(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
TELEPHONE:
(818) 596-4370
Leslie Ngo-Castaneda
TELEPHONE:
(818) 214-9900
DATE:
11/12/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/12/2024
LIC809
(FAS) - (06/04)
Page:
11
of
22
Document Has Been Signed on
11/13/2024 09:04 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER:
197609700
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Other Provisions
(c) The training shall include, but not be limited to, all of the following: (1) Physical limitations and needs of the elderly.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Section Cited
Other Provisions
(c) The training shall include, but not be limited to, all of the following: (2) Importance and techniques for personal care services.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
TELEPHONE:
(818) 596-4370
Leslie Ngo-Castaneda
TELEPHONE:
(818) 214-9900
DATE:
11/12/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/12/2024
LIC809
(FAS) - (06/04)
Page:
12
of
22
Document Has Been Signed on
11/13/2024 09:04 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER:
197609700
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Other Provisions
(c) The training shall include, but not be limited to, all of the following: (3) Residents’ rights.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Section Cited
Other Provisions
(c) The training shall include, but not be limited to, all of the following: (4) Policies and procedures regarding medications.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
TELEPHONE:
(818) 596-4370
Leslie Ngo-Castaneda
TELEPHONE:
(818) 214-9900
DATE:
11/12/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/12/2024
LIC809
(FAS) - (06/04)
Page:
13
of
22
Document Has Been Signed on
11/13/2024 09:04 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER:
197609700
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Other Provisions
(c) The training shall include, but not be limited to, all of the following: (5) Psychosocial needs of the elderly.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Section Cited
Other Provisions
(c) The training shall include, but not be limited to, all of the following: (6) Building and fire safety and the appropriate response to emergencies.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
TELEPHONE:
(818) 596-4370
Leslie Ngo-Castaneda
TELEPHONE:
(818) 214-9900
DATE:
11/12/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/12/2024
LIC809
(FAS) - (06/04)
Page:
14
of
22
Document Has Been Signed on
11/13/2024 09:04 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER:
197609700
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Other Provisions
(c) The training shall include, but not be limited to, all of the following: (9) Cultural competency and sensitivity in issues relating to the underserved, aging, lesbian, gay, bisexual, and transgender community.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Section Cited
Personnel Requirements - General
(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
TELEPHONE:
(818) 596-4370
Leslie Ngo-Castaneda
TELEPHONE:
(818) 214-9900
DATE:
11/12/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/12/2024
LIC809
(FAS) - (06/04)
Page:
15
of
22
Document Has Been Signed on
11/13/2024 09:04 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER:
197609700
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Personnel Requirements - General
(6) The licensee shall maintain documentation pertaining to staff training in the personnel records, as specified in Section 87412(c)(2). For on-the-job training, documentation shall consist of a statement or notation, made by the trainer, of the content covered in the training. Each item of documentation shall include a notation that indicates which of the criteria of Section 87411(c)(3) is met by the trainer.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Section Cited
Other Provisions
(a) All residential care facilities for the elderly shall meet the following training requirements, as described in Section 1569.625, for all direct care staff: (1) Twelve hours of dementia care training, six of which shall be completed before a staff member begins working independently with residents, and the remaining six hours of which shall be completed within the first four weeks of employment. All 12 hours shall be devoted to the care of persons with dementia. The facility may utilize various methods of instruction, including, but not limited to, preceptorship, mentoring, and other forms of observation and demonstration. The orientation time shall be exclusive of any administrative instruction.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
TELEPHONE:
(818) 596-4370
Leslie Ngo-Castaneda
TELEPHONE:
(818) 214-9900
DATE:
11/12/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/12/2024
LIC809
(FAS) - (06/04)
Page:
16
of
22
Document Has Been Signed on
11/13/2024 09:04 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER:
197609700
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Other Provisions
(a) All residential care facilities for the elderly shall meet the following training requirements, as described in Section 1569.625, for all direct care staff: (2) Eight hours of in-service training per year on the subject of serving residents with dementia. This training shall be developed in consultation with individuals or organizations with specific expertise in dementia care or by an outside source with expertise in dementia care. In formulating and providing this training, reference may be made to written materials and literature on dementia and the care and treatment of persons with dementia. This training requirement may be satisfied in one day or over a period of time. This training requirement may be provided at the facility or offsite and may include a combination of observation and practical application.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
TELEPHONE:
(818) 596-4370
Leslie Ngo-Castaneda
TELEPHONE:
(818) 214-9900
DATE:
11/12/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/12/2024
LIC809
(FAS) - (06/04)
Page:
17
of
22
Document Has Been Signed on
11/13/2024 09:04 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER:
197609700
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Other Provisions
(a) All residential care facilities for the elderly shall provide training to direct care staff on postural supports, restricted conditions or health services, and hospice care as a component of the training requirements specified in Section 1569.625. The training shall include all of the following: (2) Four hours of training thereafter of in-service training per year on the subject of serving those residents.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Section Cited
Other Provisions
(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (4) The training shall cover all of the following areas: (A) The role, responsibilities, and limitations of staff who assist residents with the self-administration of medication, including tasks limited to licensed medical professionals.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
TELEPHONE:
(818) 596-4370
Leslie Ngo-Castaneda
TELEPHONE:
(818) 214-9900
DATE:
11/12/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/12/2024
LIC809
(FAS) - (06/04)
Page:
18
of
22
Document Has Been Signed on
11/13/2024 09:04 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER:
197609700
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Other Provisions
(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (4) The training shall cover all of the following areas: (B) An explanation of the terminology specific to medication assistance.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Section Cited
Other Provisions
(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (4) The training shall cover all of the following areas: (C) An explanation of the different types of medication orders: prescription, over-the-counter, controlled, and other medications.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
TELEPHONE:
(818) 596-4370
Leslie Ngo-Castaneda
TELEPHONE:
(818) 214-9900
DATE:
11/12/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/12/2024
LIC809
(FAS) - (06/04)
Page:
19
of
22
Document Has Been Signed on
11/13/2024 09:04 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER:
197609700
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Other Provisions
(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (4) The training shall cover all of the following areas: (D) An explanation of the basic rules and precautions of medication assistance.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Section Cited
Other Provisions
(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (4) The training shall cover all of the following areas: (E) Information on medication forms and routes for medication taken by residents.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
TELEPHONE:
(818) 596-4370
Leslie Ngo-Castaneda
TELEPHONE:
(818) 214-9900
DATE:
11/12/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/12/2024
LIC809
(FAS) - (06/04)
Page:
20
of
22
Document Has Been Signed on
11/13/2024 09:04 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER:
197609700
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Other Provisions
(b) Each employee who received training and passed the examination required in paragraph (5) of subdivision (a), and who continues to assist with the self-administration of medicines, shall also complete eight hours of in-service training on medication-related issues in each succeeding 12-month period.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Section Cited
Other Provisions
(d) Each residential care facility for the elderly that provides employee training under this section shall use the training material and the accompanying examination that are developed by, or in consultation with, a licensed nurse, pharmacist, or physician. The licensed residential care facility for the elderly shall maintain the following documentation for each medical consultant used to develop the training: (4) The training topics for which consultation was provided.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S3 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
S3 needs training before starting in facility.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
TELEPHONE:
(818) 596-4370
Leslie Ngo-Castaneda
TELEPHONE:
(818) 214-9900
DATE:
11/12/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/12/2024
LIC809
(FAS) - (06/04)
Page:
21
of
22
Document Has Been Signed on
11/13/2024 09:04 AM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
BRILLIANT SENIOR CARE FACILITY
FACILITY NUMBER:
197609700
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
11/12/2024
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Medical Assessment
(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by the facility.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 3 out of 5 residents does not have TB test (R2, R4 and R5) which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
11/26/2024
Plan of Correction
1
2
3
4
Licensee needs to ensure TB test to be done for residents upon admitting them to the facility.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
TELEPHONE:
(818) 596-4370
Leslie Ngo-Castaneda
TELEPHONE:
(818) 214-9900
DATE:
11/12/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/12/2024
LIC809
(FAS) - (06/04)
Page:
22
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