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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610045
Report Date: 06/21/2024
Date Signed: 06/21/2024 01:02:00 PM

Document Has Been Signed on 06/21/2024 01:02 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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:MONTARE ON THE HILLFACILITY NUMBER:
197610045
ADMINISTRATOR/
DIRECTOR:		HOWARD, IANFACILITY TYPE:
772
ADDRESS:4156 SUNSWEPT DRTELEPHONE:
(203) 823-8588
CITY:STUDIO CITYSTATE: CAZIP CODE:
91604
CAPACITY: 6CENSUS: 6DATE:
06/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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At 8:35 a.m. on 06/21/2024, Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced annual inspection. LPA met with staff and disclosed the reason for the visit. LPA and staff toured the facility inside and out.

A tour of the physical plant was conducted at 9:25a.m. and the following was noted:



It is a two story building with 4 bedrooms, 5 bathrooms, central nurse station, kitchen, garage, common areas, case management room, 2 therapist rooms, pool, and outdoor areas. It has an approved fire clearance for 6 ambulatory clients. The facility uses surveillance cameras inside and outside.

Entry: Upon entry, LPA observed signs hung for the facility’s COVID policies. Staff screened LPA for infectious disease symptoms and temperature.

Nurse Station: Room contained client and staff records, medication, therapy space, first aid, and facility postings. All medication and records were locked. The room also serves as an office.

Bedrooms: The facility has 4 bedrooms. 2 are private and 2 are shared. Bedrooms are assigned by gender. All bedrooms contained a chair, night stand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition. Bedroom #2 contained a non-operational fireplace with appropriate covering.

Bathrooms: The facility has 5 bathrooms. All bathrooms were sanitary and contained liquid soap, paper towels, hand washing instruction sign, and trash cans. LPA measured the water temperature in bathrooms to be between 115.7- 119.1 degrees Fahrenheit.

Kitchen: LPA observed an adequate supply of perishable and non-perishable food. LPA measured the refrigerator and freezer temperatures to be 34 and -5 degrees Fahrenheit, respectively. A temperature log was hung on the front of the refrigerator. The stove hood was clean and free of debris. Knives were locked below the island counter top.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2024
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 2
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: MONTARE ON THE HILL
FACILITY NUMBER: 197610045
VISIT DATE: 06/21/2024
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Laundry: LPA and staff entered the garage and observed extra water, food, PPE, first aid supplies and a second refrigerator. LPA and staff arrived at the laundry room. The laundry room was locked by a number pad on the handle. All detergent inside was locked as well. LPA observed a washer and dryer in good condition.

Common Areas: Walls, floors, ceilings, windows, and screens were clean and in good repair. LPA observed activities, a billiards table, board games, books, and art supplies in the living room and dining area. Postings for daily schedules, weekly schedules, personal rights, emergency contacts, confidential complaints, and ombudsman contacts were posted. LPA measured the room temperature to be 70 degrees Fahrenheit.

Case Management Room: The room contained a desk, chairs, activities and instructional material.

Safety: All emergency exit paths were unlocked and free from obstructions. 3 out of 3 exit doors were unlocked. Emergency Disaster Plan posted at the front. Emergency exits maps were posted throughout the facility. LPA observed the 2024 smoke detector test log. 11 out of 11 facility smoke detectors were tested each month and operational. Fire extinguisher monthly tests were also recorded. LPA observed 3 fully charged fire extinguishers outside the nurse room and by bedrooms. Last natural disaster drill was conducted on 05/20/2024.

Outdoor areas: The facility has fitness equipment out front of the main entrance. Stairs with non-skid strips led down to a fenced and locked pool area. LPA observed pool rules hung on the gate. All areas were clean and free from hazards. Furniture was in good condition.

During today's inspection, the facility is in compliance with Title 22 regulations.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024
LIC809 (FAS) - (06/04)
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