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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565802461
Report Date: 07/08/2022
Date Signed: 07/11/2022 09:46:04 AM


Document Has Been Signed on 07/11/2022 09:46 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:SUNRISE AT WOOD RANCHFACILITY NUMBER:
565802461
ADMINISTRATOR:EDITH KENNEDYFACILITY TYPE:
740
ADDRESS:190 TIERRA REJADA RDTELEPHONE:
(805) 584-8881
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93065
CAPACITY:100CENSUS: 79DATE:
07/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:27 AM
MET WITH:Edith KennedyTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Teresa Camara arrived at the facility unannounced to conduct a required annual visit at 09:27 a.m. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Executive Director (ED) Edith Kennedy and explained the reason for the visit.

The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The fire extinguishers are inspected monthly by maintenance staff and annually by a service; they were last inspected 07/05/2022. The carbon monoxide and fire suppression system had a full inspection 03/23/2022 and defective sprinklers (6) were replaced and reinspected 06/15/2022.

KITCHEN: The commercial kitchen was clean and appliances all appeared operable. The facility has a sufficient supply of perishable and non-perishable food as well as an emergency supply of non-perishable food and water. COMMON SPACES: The lobby, activity rooms, and dining rooms were all appropriately furnished and in good condition. The LPA observed the required postings throughout the facility. Patio areas were equipped with furniture for residents' use. ROOMS: The LPA observed randomly chosen residents' rooms in assisted living, terrace club and memory care. Rooms were appropriately furnished, clean and had sufficient lighting.

INFECTION CONTROL: During today’s visit, the LPA spoke with the ED regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening and sanitation station. All facility staff were observed wearing masks. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility has appropriate plans in place in the event of clients and/or staff showing symptoms of COVID or testing positive for COVID.

No deficiencies were observed during today's visit. Exit interview conducted. Today's report was emailed to the ED.

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:
DATE: 07/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2022
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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