197609811-7-23-2024-31-AS-NRED-D7FVQX-20240723163905

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609811
Report Date: 07/23/2024
Date Signed: 07/23/2024 04:39:49 PM

Document Has Been Signed on 07/23/2024 04:39 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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	LAND OF PEACE 6		FACILITY NUMBER:	197609811
ADMINISTRATOR:	ROSELIN FINULIAR		FACILITY TYPE:	740
ADDRESS:	22626 KITTRIDGE STREET		TELEPHONE:	(818) 884-2214
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	6	CENSUS: 6	DATE:	07/23/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Roselin Finuliar		TIME COMPLETED:	04:45 PM

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At 1:50 p.m. on 07/23/24, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced, annual inspection. LPA met with the administrator and disclosed the reason for the visit.

The facility was last visited on 07/31/22 for an annual visit. It is a single story building with six (06) bedrooms, three (03) bathrooms, kitchen, common areas, and outdoor areas. It has an approved fire clearance for six (06) residents, of which five (05) may be non-ambulatory and one (01) bedridden in Bedroom #5. The facility serves residents with dementia. Approved hospice waivers for six (06).

LPA and administrator toured the facility inside and out.

The front yard was maintained. At the main entrance, LPA observed postings for the facility license, rights of resident councils, personal rights, resident rights, emergency disaster plan, emergency contacts, confidential complaint contacts, ombudsman contacts, house rules, administrator certificates, and a blank copy of the admission agreement. Additionally, LPA observed postings at the front door and on Bedroom #3 for “No Smoking – Oxygen In Use”.

The facility has six (06) bedrooms. One (01) bedroom is designated as a staff room. The staff room was locked. All bedrooms contained a chair, nightstand, lamp, storage, and a bed with adequate bedding. All furnishings were clean and in good condition.

Walls, floors, windows, screens, and blinds were clean and in good repair. At 3:05 p.m. LPA measured the room temperature to be 77 degrees Fahrenheit. The living room contained board games, reading material, a television, and furniture in good condition. The fireplace was appropriately covered. Two (02) residents were observed relaxing in the living room.

LPA observed an adequate supply of perishable and non-perishable foods in the kitchen and detached garage. The stove hood was clean. Appliances were in good condition.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024

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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LAND OF PEACE 6	FACILITY NUMBER: 197609811
	VISIT DATE: 07/23/2024

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At approximately 3:15 p.m. LPA observed a fully charged fire extinguisher near the kitchen. It was last inspected on 03/28/24. Sharps were locked below the counter. Cleaning solutions were locked above the washer and dryer. Medications were locked above the counter top. The washing machine and dryer were both were in working order.

The facility has four (04) bathrooms. Two (02) bathrooms are private, and two (02) are shared. All bathrooms contained liquid soap, paper towels, trash can with a lid, grab bars near the toilet and shower or a commode, and a non-skid mat in the shower. At approximately 3:25 p.m. LPA measured the water temperature in the shared bathroom to be 109.7 degrees Fahrenheit.

LPA observed a covered patio area in the rear of the facility. The patio contained furniture in good condition. The ramp leading out was free of debris and had sturdy rails.

Two (02) out of two (02) emergency exit paths were free from obstructions. Evacuation routes were posted. Three (03) out of three (03) auditory alarms were turned on and functioning. At approximately 3:45 p.m., smoke and carbon monoxide detectors were tested and operational. Detectors functioned simultaneously, and the fire door in the hallway closed.

During today's inspection, the facility was in compliance with Title 22 regulations. No immediate health and safety risks were observed during today’s visit.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024

LIC809 (FAS) - (06/04)

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