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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320127
Report Date: 03/27/2024
Date Signed: 03/27/2024 02:45:19 PM


Document Has Been Signed on 03/27/2024 02:45 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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245



FACILITY NAME:WATERMARK AT WESTWOOD VILLAGE, THEFACILITY NUMBER:
198320127
ADMINISTRATOR:LILIT MNATSAKANYANFACILITY TYPE:
740
ADDRESS:947 TIVERTON AVENUETELEPHONE:
(310) 208-4590
CITY:LOS ANGELESSTATE: CAZIP CODE:
90024
CAPACITY:237CENSUS: 102DATE:
03/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lilit MnatsakanyanTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one- year inspection. LPA met with Mariam Gezalian (Business Office Manager) and Lilit Mnatsakanvan ( Executive Director) and the purpose of the visit was discussed. Facility is licensed to serve 237 non ambulatory ages 60 and over of which 25 maybe bedridden on the 3rd floor and below is approved for bedridden. #rd floor only approved for delayed egress. A hospice waiver is approved for 25 residents. The facility does not handle any of the residents’ money:

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


No pool or jacuzzi onsite but pets will be allowed.

LPA toured (5) Resident bedrooms and bathrooms, bed linens and closet/drawer space to accommodate each resident comfortably. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured between 118 and 120F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Sparkle DayTELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024
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
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: WATERMARK AT WESTWOOD VILLAGE, THE
FACILITY NUMBER: 198320127
VISIT DATE: 03/27/2024
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Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly and fire extinguisher was fully charged. Carbon monoxide detector was operational Fire drills are conducted and documented quarterly for each floor.. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the facility were clear of hazards. There are no security bars or weapons on the premises.

No Deficiencies were cited. A copy of the report was left Executive Director Lilit Mn

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Sparkle DayTELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
LIC809 (FAS) - (06/04)
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