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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197690045
Report Date: 09/19/2024
Date Signed: 09/19/2024 01:42:32 PM

Document Has Been Signed on 09/19/2024 01:42 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:ELEVATION BEHAVIORAL HEALTHFACILITY NUMBER:
197690045
ADMINISTRATOR/
DIRECTOR:		GREG RIGALIFACILITY TYPE:
772
ADDRESS:3855 BRUNSTON COURTTELEPHONE:
(818) 877-0934
CITY:WESTLAKE VILLAGESTATE: CAZIP CODE:
91362
CAPACITY: 6CENSUS: 0DATE:
09/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Matthew MuellerTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Angela Barutyan arrived at the facility announced at 10:30AM to conduct a required annual visit. The facility did not have any clients or staff on site upon arrival. LPA spoke with Operations Director (OD) Matthew Mueller telephonically who arrived at the facility with HR Director (HRD) Gregory Allen. LPA met with OD Mueller and HRD Allen at 11AM and explained the reason for the visit. Clinical Director Amarilys Reyes arrived to the facility at 11:26AM during the visit.

Due to conflicts between the Licensee and the property owner that directly impact the health and safety of clients, all client(s) have been relocated on 09/11/2024 to licensed facility 195850386. The Licensee has removed required postings, fire extinguishers, lockboxes, and other operational requirements in the event that an agreement with the property owner cannot be reached and equipment cannot be accessed by the Licensee. OD Mueller informed the LPA that the facility does not anticipate accepting any clients in the foreseeable future until an agreement between the Licensee and property owner can be reached. Licensee is notified that any decision to cease operation at this location or to accept new clients shall be notified to the Department.

Beginning at 11:03AM, the LPA, along with the OD toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

The facility is currently vacant. Required postings, fire extinguishers, medication cabinet and cleaning closet locks, and furniture in common areas were missing. This does not pose a health or safety risk as there are no clients currently in care at this location. Hardwired smoke and carbon monoxide detectors were tested at 12:12PM and all were functional at the time of the visit.

COMMON AREAS: These include the Living Room, Dining Room, Great Room and Gym located on the ground floor and the Library and Movie Theater located on the second floor. LPA observed the living, dining, gym, and theater rooms to be appropriately furnished. LPA observed facility sketch posted throughout common areas. Report Continued on LIC 809-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ELEVATION BEHAVIORAL HEALTH
FACILITY NUMBER: 197690045
VISIT DATE: 09/19/2024
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BEDROOMS: There are six (6) bedrooms designated for single-client use of which three (3) are upstairs and three (3) are downstairs. Bedrooms were appropriately furnished with beds, night stands, adequate lighting, chests of drawers, and closet space. Bedroom #1 has a screened fireplace.

RESTROOMS: The facility has six (6) restrooms of which one (1) is a private restroom attached to Bedroom #1, two (2) are adjacent to client bedrooms in the hallway, one (1) is attached and shared by two (2) client bedrooms, one (1) is a common restroom by the facility entrance, and one (1) is in the detached building, formerly the pool house. Restrooms were observed to be clean and sanitary with hand soap, paper towels, and toilet paper. At 11:10AM, the hot water temperature measured at 112.7 degrees Fahrenheit which is within the required range.

OFFICE, STAFF & TREATMENT AREAS: The detached building (formerly a Pool House) has been designated as the Clinical Office and has an attached bathroom. LPA observed the building to be empty.



SURROUNDING GROUNDS: The property is fenced and gated. The front yard includes a driveway both covered and uncovered. The grounds to the east of the dwelling include patio and garden areas and a barbeque. The backyard includes an in-ground pool and hot tub, a fire pit, a putting green, a basketball court as well as lawn, garden and other landscaped areas. The grounds on the west side of the facility include gardens and walkways. LPA observed the pool to be appropriately fenced.

RECORD REVIEW: Beginning at 11:42AM, LPA reviewed five (5) staff files for documents including but not limited to: TB test, health screening, staff training, First Aid and CPR training, and fingerprint clearance. All five (5) staff files reviewed were in compliance with regulation at the time of the visit.



INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today's visit, LPA reviewed the facility's infection control policy as well as the emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan is updated annually as required. Emergency disaster drills are conducted quarterly as is required, with the last drill conducted on 09/02/2024.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC809 (FAS) - (06/04)
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