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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565850150
Report Date: 05/02/2024
Date Signed: 05/02/2024 10:53:49 AM

Document Has Been Signed on 05/02/2024 10:53 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:VARENITA OF WESTLAKEFACILITY NUMBER:
565850150
ADMINISTRATOR/
DIRECTOR:		VEJAR, MERIFACILITY TYPE:
740
ADDRESS:95 DUSENBERG DRIVETELEPHONE:
(805) 413-3300
CITY:WESTLAKESTATE: CAZIP CODE:
91362
CAPACITY: 90CENSUS: 90DATE:
05/02/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Mark Brassfield, Wellness DirectorTIME VISIT/
INSPECTION COMPLETED:
10:54 AM
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Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a Case Management visit with the purpose of verifying a pending increase in capacity for the facility. LPA arrived at 09:10AM and was greeted by front desk staff. LPA then met with Wellness Director Mark Brassfield, as Executive Director was not available upon arrival. Wellness Director is authorized to sign all reports.

A capacity change was requested for the facility to increase capacity from 90 residents to 115. Fire clearance was granted on 04/24/2024 for 8 bedridden residents and 107 non-ambulatory, with 115 total capacity.

During today's visit, LPA, along with Wellness Director, toured the facility beginning at 10:24AM. No physical plant or health and safety concerns were noted during today's visit.

No citations issued. Exit interview conducted. A copy of today's report was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2024
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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