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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609969
Report Date: 02/26/2024
Date Signed: 02/26/2024 04:59:20 PM


Document Has Been Signed on 02/26/2024 04:59 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:VALLEY VISTA SENIOR LIVINGFACILITY NUMBER:
197609969
ADMINISTRATOR:ELIZABETH J WHITTINGTONFACILITY TYPE:
740
ADDRESS:7040 VAN NUYS BLVDTELEPHONE:
(818) 906-4400
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY:164CENSUS: 64DATE:
02/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Elizabeth Whittington, Executive DirectorTIME COMPLETED:
05:15 PM
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Licensing Program Analysts (LPAs) Emily Peraldi and Sandra Urena conducted an unannounced Case Management - Incident inspection. At 10:05 a.m., the LPAs were greeted and screened by staff. At 10:15 a.m., the LPAs met with the Executive Director (ED), Elizabeth Whittington and explained the reason for the visit.

The reason for today's inspection is to follow up on one (1) self-reported Report of Suspected Dependent Adult/Elder Abuse (SOC 341) submitted on 02/14/2024 regarding Resident #1 (R1). During the time of the visit, the LPAs obtained copies of pertinent documents. At 10:36 a.m., the LPAs along with the Executive Director conducted a physical plant tour.

No immediate health and safety concerns were observed during today's inspection.

Further investigation is required at this time. An additional report may follow if warranted.

Exit interview conducted. A copy of the report was provided.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Emily PeraldiTELEPHONE: 818-421-4497
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2024
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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