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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320127
Report Date: 11/07/2024
Date Signed: 11/07/2024 11:46:29 AM

Document Has Been Signed on 11/07/2024 11:46 AM - 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/
DIRECTOR:		STEPHANIE KOFFMANFACILITY TYPE:
740
ADDRESS:947 TIVERTON AVENUETELEPHONE:
(310) 208-4590
CITY:LOS ANGELESSTATE: CAZIP CODE:
90024
CAPACITY: 237CENSUS: DATE:
11/07/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Sthephanie Koffman/Senior Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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On November 7, 2024, Licensing Program Analyst (LPA) Alfonso Iniguez conducted a Case Management visit. The LPA met with Stephanie Koffman, Senior/Executive Director, and explained the purpose of the visit.

While conducting another Case Management at the facility, LPA Iniguez requested more documentation regarding open investigation pertaining to complaint #11-AS-20240910162855. The Senior Executive Director provided copies of the documentation.

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

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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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