198320127-8-30-2024-11-AS-AINZ-D8MRMR-20240830130912

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320127
Report Date: 08/30/2024
Date Signed: 08/30/2024 01:09:17 PM

Document Has Been Signed on 08/30/2024 01:09 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, THE		FACILITY NUMBER:	198320127
ADMINISTRATOR:	LILIT MNATSAKANYAN		FACILITY TYPE:	740
ADDRESS:	947 TIVERTON AVENUE		TELEPHONE:	(310) 208-4590
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90024
CAPACITY:	237	CENSUS: 98	DATE:	08/30/2024
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	11:09 AM
MET WITH:	Stephanie Koffman/Senior Executive Director		TIME COMPLETED:	01:08 PM

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On 8/30/24, Licensing Program Analysts (LPAs) Alfonso Iniguez and Yolanda Rosser conducted an unannounced Case Management visit at the community named above. The LPAs met with Stephanie Koffman, Senior Executive Director, and explained the reason for the visit in detail.

On 8/28/2024, the El Segundo Regional Office received reports of a male dressed as a service worker entering community care facilities in the Westwood area.

The Executive Director stated that the facility has many security filters, including the parking lot, main entrance, and elevator access. She stated that on the day of the occurrence, the individual just walked in using the main entrance door at approximately 11:30 AM and was escorted out at 12:08 PM. In addition, the Executive Director stated that the receptionist had just stepped out from the front desk to make a copy when the individual walked by and got into the community.

The Executive Director emphasized the facility's commitment to staff training and safety. She stated that on the day of the event, there were sufficient staff at the facility. In addition, she highlighted the all-staff In service they conducted regarding these events, demonstrating their proactive approach to alerting everyone and keeping a close eye on security.

The Executive Director stated that the residents who had their items stolen signed the form for Safeguard of Property and Valuables but did not list any personal items.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024

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: 08/30/2024

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During this visit LPAs conducted the following:

-A health and safety check of the facility.

-Copies of the staff roster and resident’s roster.

-LPAs received copies of pictures of the intruder that went inside facility.

-Copies of Staff in-service training

-Copies of resident SPV form and theft and lost procedures admissions agreement.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPAs did not observe deficiencies therefore no citations were issued at this time.

An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Stephanie Koffman/Senior Executive Director

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024

LIC809 (FAS) - (06/04)

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