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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610153
Report Date: 07/23/2024
Date Signed: 07/23/2024 12:57:03 PM


Document Has Been Signed on 07/23/2024 12:57 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:WINDSCAPE SENIOR CAREFACILITY NUMBER:
197610153
ADMINISTRATOR:AGARONYAN, RIMAFACILITY TYPE:
740
ADDRESS:7636 KENTLAND AVETELEPHONE:
(818) 720-8870
CITY:WEST HILLSSTATE: CAZIP CODE:
91304
CAPACITY:6CENSUS: 5DATE:
07/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Naira Khachatryan, StaffTIME COMPLETED:
01:20 PM
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At 10:20am, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA met with Staff #1, who granted access to the facility. LPA explained the reason for the visit.

At 10:30am LPA conducted a tour of the physical plant and observed the following:

Facility is licensed for capacity of six (6) of which The facility has a fire clearance for six non-ambulatory residents, one of which may be bedridden in room 2 or 4. Facility also has a hospice waiver for five (5) residents. There are four (4) bedrooms designated for residents use. Bedrooms are appropriately furnished and have appropriate lighting. Bathrooms have soap, paper towels and hand washing signs were observed. The hot water temperature measured at 119.5°F. Extra towels and linens were readily available. During the visit LPA did not observe any immediate health and safety concerns. Facility maintains a temperature of 73°F. LPA observed there to be sufficient stock of one-week perishable foods and two-day non-perishable foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Sharps, cleaning supplies and medications are centrally stored and are kept locked in various kitchen cabinets and drawers. The fire extinguisher was observed in the kitchen area and was last purchased on 09/23/2023. Laundry is located by the room #4, and LPA observed all chemicals and detergents are kept locked and inaccessible to residents in care. LPA aslo observed a clean covered patio and backyard furniture to accommodate the six (6) residents. Smoke detectors and carbon monoxide monitors were tested at 11:05pm and observed to be functional. Between 11:30am to 12:30pm, LPA reviewed records of five (5) clients and two (2) staff. Resident and staff records appeared to be complete and updated. LPA collected Certificate of Liability Insurance and LIC500.

No citations issued during this visit.
Exit interview conducted and copy of this report signed and delivered.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
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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