198320127-3-18-2021-11-AS-TAGD-BZ8S3C-20210318133056

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320127
Report Date: 03/16/2021
Date Signed: 03/18/2021 01:31:12 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	WATERMARK AT WESTWOOD VILLAGE, THE		FACILITY NUMBER:	198320127
ADMINISTRATOR:	MURPHY, PATRICIA		FACILITY TYPE:	740
ADDRESS:	947 TIVERTON AVENUE		TELEPHONE:	(310) 208-4590
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90024
CAPACITY:	237	CENSUS: 0	DATE:	03/16/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Patricia Murphy		TIME COMPLETED:	12:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Troy Agard, conducted an announced virtual visit to the facility for the purpose of a pre-licensing evaluation. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today's visit was conducted via FaceTime with Administrator / Executive Director, Patricia Murphy. An application was submitted to CCLD on 09/08/2020, for an Initial license for a Residential Care Facility for the Elderly to serve assisted living, independent living and residents with memory care needs, 60 years and older. The requested capacity is for 237 of which 212 may be non-ambulatory, and 25 may be bedridden. Structure: Facility has approx. 188- living units, approx. 225 bathrooms, 14 stories with underground parking. The facility is beige in color and consist mostly of glass. On the first floor, the facility has a full catering kitchen, dining area, lobby, conference room space, restrooms, reception area, 3 elevators and a sitting area with an enclosed fireplace. There is also a large outdoor patio with a fireplace and seating. On the second floor, there is a salon and fitness center, storage space and administrative office space. The third floor consist of residential space for individuals that need support with memory care. There is a total of 18 apartments, a dining space with patio and some office space. Floors four to seven consist of residential space for assisted living. Floors eight to fourteen consist of units for independent living. All units come unfurnished. The units are spacious and will easily accommodate furnishings. There are no open bodies of water on the premises. All passageways, walkways, driveways, steps and patios are free from obstructions. Front, back and side areas are free of hazards. Building is equipped with a backup generator on-site. Facility has a full sprinkler system.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2021

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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: WATERMARK AT WESTWOOD VILLAGE, THE	FACILITY NUMBER: 198320127
	VISIT DATE: 03/16/2021

NARRATIVE

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Bedrooms:
LPA observed the resident’s bedrooms (Studio, 1 and 2 bedroom), all non-ambulatory. Residents are required to bring their own furnishings. Units come with plenty of space to accommodate furniture and there was ample closet space. Some units come with in-unit washer and dryer.

Bathrooms:
All bathrooms have a working toilet, wash basin, and shower. All bathrooms accommodate non-ambulatory clients in a wheelchair.

Linens & Hygiene Supplies:
Facility does not supply linen or hygiene supplies. Residents are required to bring linen and hygiene supplies with them during move in.

Emergency Phone Numbers, Exit Plan & Menu:
Facility has a landline and postings of the floor/ exit plan were noted near the elevator. Menus will be made available to residents.
Fire Extinguishers located throughout the kitchen.

Food Service:
Dishes, cups and flat ware are stored in the kitchen cupboards and staged on dining room tables, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are stored in a locked drawer in the kitchen inaccessible to residents. (Residents are not allowed in the catering kitchen). In the memory care unit, utensils are stored away. Adequate food supply stored in 2 large walk-in refrigerators and one large freezer. Dishwasher in kitchen properly installed and functioning.

Smoke Detectors:
LPA observed dual smoke/carbon monoxide detectors that are hardwired and interconnected. The fire alarm system will automatically dial the fire department in the event of an emergency.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2021

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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: WATERMARK AT WESTWOOD VILLAGE, THE	FACILITY NUMBER: 198320127
	VISIT DATE: 03/16/2021

NARRATIVE

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Appliances:
Stove burners, oven, microwave, dishwasher, washer and dryer are in working order. There are two large walk-in refrigerators in the facility and one large freezer. Each unit, with the exception of memory care, have a refrigerator and kitchenette with induction cooktops. Tested refrigerators have a measured temperature of at least 45 degrees Fahrenheit. Freezer is at 0 degrees Fahrenheit. The facility is equipped with central air and heat in each unit. Units can be individually climate controlled.

Toxins:
Toxins and sharps will be locked/stored separate to residents

Water Temperature:
Tested at an average of 117 degrees.

Medications, First-Aid Kit & Book:
A first aid kit has been inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, and gauze. Facility will purchase a first aid manual, which are stored and available for staff use but inaccessible to clients. Medications will be stored according to the needs of the individual being supported.

Clients & Staff Files:

Facility will not be handling cash resources of residents. Records of staff and residents will be stored in a locked cabinet in a locked office. Digital copies will also be a form of storage.

Reading Material, Games, Equipment & Materials:
The facility has board games, books, and other recreational materials for the resident's use, commensurate with the plan of operation.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2021

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
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: WATERMARK AT WESTWOOD VILLAGE, THE	FACILITY NUMBER: 198320127
	VISIT DATE: 03/16/2021

NARRATIVE

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Pool/Jacuzzi & Pets:
No pool or jacuzzi onsite but pets will be allowed.

Fire clearance:
Facility is cleared for a capacity of 237 of which 212 may be non-ambulatory and 25 may be bedridden. Facility is approved for a delayed egress on the third floor only. All bedridden room shall be kept on the third floor only, per fire inspection. Inspection was approved on 02/26/2021

Pre-licensing Checklist:
Completed by Administrator and reviewed by LPA

Component III:

Conducted at the Pre-Licensing visit, information was provided about how to operate the facility within substantial compliance.
During the prelicensing inspection there were no items observed which do not comply with applicable laws and regulations.

An exit interview was conducted, and a copy of this report has been furnished to the applicant. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Unit (CAU) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAU Analyst assigned to their application.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2021

LIC809 (FAS) - (06/04)

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