198320197-4-28-2021-11-AS-TAGD-C2HT7E-20210428142836

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320197
Report Date: 04/19/2021
Date Signed: 04/28/2021 02:29:27 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:	PLAZA AT WESTWOOD, THE		FACILITY NUMBER:	198320197
ADMINISTRATOR:	ZENTENO, VIRGINIA		FACILITY TYPE:	740
ADDRESS:	2228 WESTWOOD BLVD		TELEPHONE:	(323) 217-7877
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90064
CAPACITY:	136	CENSUS: 41	DATE:	04/19/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Sholomo "Steven" Aron		TIME COMPLETED:	11:00 AM

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 visit to the above facility for purpose of a pre-licensing evaluation. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s inspection was conducted via FaceTime with Licensee Representative, Shlomo “Steven” Aron. During the inspection LPA toured the inside and outside of the facility and verified the address of the location. An application was submitted to CCLD on 03/02/2021 for a change of ownership for a Residential Care Facility for the Elderly to serve seniors and seniors with dementia, ages 60 years and greater. The requested capacity is for 136. 130 non-ambulatory and 6 bedridden. Facility has a fire clearance dated for 04/07/2021. Structure: Facility is a 68 resident-bedroom, approx.74-bathroom, three-story building. 1st floor consists of a lobby area, laundry facility, staff break room and an adjacent parking structure. 2^nd floor consists of residential rooms, dining room, kitchen, outdoor patio, media room and medication room. The 3^rd floor consists of resident rooms and storage. The Resident bedrooms are spacious and easily accommodate furnishings. There is a shaded patio / courtyard area with tables and chairs. Shaded area has sufficient tables and chairs for residents. Outdoor passageways, walkways, driveways, steps and patios are free from obstructions. LPA did not observe hazards, such as ladders, gardening tools and/or motorized equipment in the front, back and/or side areas of the facility. Bedrooms: All bedrooms have a chair, nightstands, over-head lighting, dressers and closets. The closets and drawers comply with the requirement of 8 cubic feet of space. Office: Facility has few offices with desk, chairs and cabinets with staff records, and resident records.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2021

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: PLAZA AT WESTWOOD, THE	FACILITY NUMBER: 198320197
	VISIT DATE: 04/19/2021

NARRATIVE

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Bathrooms: Facility has approx. 74 bathrooms (68 full baths and 6 half). Bathrooms where observed to have a working toilet, wash basin and shower.

Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen; sheets, pillowcases, bath towels are provided. Facility does not provide hygiene supplies to residents.

Emergency Phone Numbers, Exit Plan & Menu: The telephone, which is a land line, was called by LPA and is operational. Emergency Disaster Plan and "See something, Say something, Let Us Know" posted & readily available for review on the wall throughout the facility. Fully charged fire extinguishers was found throughout the facility.

Food Service: Dishes, cups and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are stored in a locked drawer in kitchen. Food supply was adequately stored in kitchen refrigerator, cabinets and pantry and consists of the following: a variety of fresh and canned fruit, vegetables and meats all dated.

Smoke Detectors: dual smoke and carbon monoxide detectors are hardwired and interconnected. All were operational linked to the fire department.

Appliances: Stove burners, oven, microwave, washer, and dryer are in working order. There is 1 large walk-in refrigerator in the kitchen and 1 large walk-in freezer. Refrigerator and freezer are at the correct temperature for food storage.

Toxins: Locked/stored and inaccessible to residents.

Medications, First-Aid Kit & Book: Area for medication storage is in medication room. First aid kit was inspected which has at least the following: thermometer, tweezers, scissors, antiseptic, bandages, gauze. First aid and medications are available for staff use but inaccessible to clients.

Clients & Staff Files: Records of staff and clients are stored and locked in the office of the Administrator.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2021

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: PLAZA AT WESTWOOD, THE	FACILITY NUMBER: 198320197
	VISIT DATE: 04/19/2021

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Reading Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the client's use as well as an activity calendar.

Pool/Jacuzzi & Pets: LPA's did not observe any pet or bodies of water at the facility.

Fire clearance: Fire Clearance was approved on 04/07/2021 for 130 non-ambulatory and 6 bedridden residents. LPA did not observe pad locks or other mechanisms which may be obstructions for safe and quick egress during an emergency on front and back exits.

Component III: Conducted at the Pre-Licensing visit, on 04/19/2021 at PLAZA AT WESTWOOD, THE. Information was provided about how to operate the facility within substantial compliance.

During the pre-licensing inspection no items were observed which do not comply with applicable laws and regulations; no items require a follow up inspection for verification of correction.

Pre-Licensing is complete, and this facility has no deficiencies.

An exit interview was conducted, and a copy of this report has been furnished to the applicant via email for signature.

Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to the applicant.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2021

LIC809 (FAS) - (06/04)

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