421703158-7-15-2024-29-AS-MRAN-D77VFA-20240715162336

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 421703158
Report Date: 07/15/2024
Date Signed: 07/15/2024 04:23:41 PM

Document Has Been Signed on 07/15/2024 04:23 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	SOLVANG FRIENDSHIP HOUSE		FACILITY NUMBER:	421703158
ADMINISTRATOR:	TAMMY WESTWOOD		FACILITY TYPE:	740
ADDRESS:	880 FRIENDSHIP LANE		TELEPHONE:	(805) 688-8748
CITY:	SOLVANG	STATE: CA	ZIP CODE:	93463
CAPACITY:	40	CENSUS: 30	DATE:	07/15/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:02 AM
MET WITH:			TIME COMPLETED:	04:30 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) Rankin arrived at 10:01 am to conduct a 1-year annual visit to the facility above. LPA met Administrator Tammy Westwood and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Infection Control: The facility has submitted a current Mitigation Plan, Infection Control Plan, Emergency Disaster Plan and provided plans to the department. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has a 30-day supply of PPE. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). All trash cans and waste baskets have tight fitting covers. Physical Plant & Environment Safety: The facility is clean, safe, and sanitary. LPA was authorized to enter and inspect facility. The dual smoke and carbon monoxide detectors are hard wired along with a sprinkler system and are operational, last reviewed and tested by an inspector on 5/28/24. Fire extinguishers located in several areas throughout the property were inspected on 6/12/24 and were charged in the green. There are no issues noted at this time fire clearances. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The facility kitchen is clean, safe, and sanitary. The showers have non-skid mats and/or surfaces. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care. The facility has telephone and internet service for resident use.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Melisa Rankin	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024

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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SOLVANG FRIENDSHIP HOUSE	FACILITY NUMBER: 421703158
	VISIT DATE: 07/15/2024

NARRATIVE

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Operational Requirements: The facility has current liability insurance and expires on 01/15/2025. The facility is approved for a capacity of 31 non-Ambulatory, 4 Bedridden and a waiver for Hospice total of 6.

Personnel Records & Training: The facility currently employes 53 staff and 1 Administrators. Staff records are kept confidential. LPA reviewed 5 staff files and required documents were present. All staff had current 1st AID/CPR. Staff had 20 plus hours of training during their facilities annual calendar. Administrator certificate expires on 03/20/2025.

Resident Records: The facility keeps separate files on each resident confidentially. Five files were reviewed for signed Admission Agreements, Medical Assessments LIC. 602A Physicians Report, ID and Emergency contact forms, Appraisal Needs and Services plans (ANS), TB results, and Personal Rights. The Facility does not handle cash resources for any of the residents in care.

Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7-day non-perishables to meet the food service requirement. All food is covered, stored, and marked appropriately. Food, snacks, and drinks are available when the residents want them. Emergency supply of food and water is available. Cleaning solutions and equipment are stored separately from food supplies. Kitchen areas are kept clean and free from litter, rodents, vermin, and insects. Kitchen staff are observed for personal hygiene and food sanitation practices.

Health Related Services: The facility uses an electronic Medication Administration Record (eMAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). Medications are stored in locked medication cabinets in most buildings, one building had a medication cart.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Melisa Rankin	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024

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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: SOLVANG FRIENDSHIP HOUSE	FACILITY NUMBER: 421703158
	VISIT DATE: 07/15/2024

NARRATIVE

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A sampling medication audit was conducted. Quarterly, a pharmacist comes to conduct a medication review, records were obtained for LPAs examination. Facility provides transportation to medical and dental appointments when needed.

Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drill last one done in April of 2024.

The courtyards of the facility have outdoor furniture, with shaded areas for residents. There are six fountains with running water, however there was enough rocks to ensure little water on the surface. No issues observed.

Planned Activities: Most residents, regardless of their abilities were out of their room among their peers and staff. There were activities noted such as gardening, puzzles, crafts, and a large, planned activity calendar.

Exit interview conducted and copy of report printed for Administrator.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Melisa Rankin	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2024

LIC809 (FAS) - (06/04)

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