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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609969
Report Date: 04/27/2023
Date Signed: 04/27/2023 03:23:18 PM


Document Has Been Signed on 04/27/2023 03:23 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 NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:VALLEY VISTA SENIOR LIVINGFACILITY NUMBER:
197609969
ADMINISTRATOR:JOLIE HIGGINSFACILITY TYPE:
740
ADDRESS:7040 VAN NUYS BLVDTELEPHONE:
(818) 906-4400
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY:164CENSUS: 68DATE:
04/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Stephanie Walters, AdministratorTIME COMPLETED:
03:30 PM
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Licensing Program Analyst(LPA) Christine Yee conducted an unannounced required Annual Inspection and met with Stephanie Walters, Administrator. The reason for the visit was explained.

On today's visit, LPA Yee conducted the Annual Inspection using the CARE Tool and focused on the following domains: Operational Requirements, Disaster Preparedness and Planned Activities. Per review of facility records and information provided, the facility has:
  • a Plan of Operation
  • maintains the appropriate fire clearance for the population being served. The facility has a fire clearance for bedridden residents
  • Emergency Disaster Plan to address relocation sites, storage of medications, contact list for emergency services and the families. Emergency drills are conducted monthly. As part of the Emergency plan, the facility has a generator for the operations of residents' medical equipment. Emergency Plan was last reviewed on 1/19/23
  • Liability Insurance that covers injury to residents and guests for the appropriate limits.
  • The facility has planned activities that are appropriate for all residents. The facility has outside areas designated for activities located by the front
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2023
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 NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: VALLEY VISTA SENIOR LIVING
FACILITY NUMBER: 197609969
VISIT DATE: 04/27/2023
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  • lobby, on the third and fourth floor.
  • has activities designed to reduce the effects of sun downing, has magazines and newspapers.


Due to time constraints, the Annual Inspection was concluded. LPA Yee will return at a later date to continue the inspection.

No citations were issued on today's visit.

Exit interview was conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
LIC809 (FAS) - (06/04)
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