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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 115920195
Report Date: 01/15/2025
Date Signed: 01/15/2025 10:05:13 AM

Document Has Been Signed on 01/15/2025 10:05 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:WESTHAVEN ASSISTED LIVINGFACILITY NUMBER:
115920195
ADMINISTRATOR/
DIRECTOR:		ELLIOTT, AARONFACILITY TYPE:
740
ADDRESS:1440 FAIRVIEW STREETTELEPHONE:
(530) 865-5299
CITY:ORLANDSTATE: CAZIP CODE:
95963
CAPACITY: 42CENSUS: 27DATE:
01/15/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Administrator Aaron ElliotTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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On 01/15/2025 Licensing Program Analyst (LPA) Ivan Avila arrived announced at the facility for a Pre-licensing inspection. LPA met with Administrator, Aaron Elliot and discussed the purpose of the visit.

During today's visit, LPA Avila and Administrator toured the interior and exterior of the facility. Areas toured included but not limited to common areas, resident bedrooms, bathroom, kitchen, and outside of the facility. LPA observed cleaning products and other toxins to be locked away. LPA observed knives and sharps found to be locked and secured in the kitchen area inaccessible to residents in care. There are seven (7) fire extinguishers that are serviced and up to date. LPA observed the facility to have the required postage on the wall. LPA and Administrator complete the pre-licensing tool together and found the facility to be in compliance.

Component III was waived during today’s inspection as Aaron Elliot is currently Administrator certified and has existing facilities.

Applicant has satisfied all requirements in accordance to Title 22, California Code of Regulations. Application is pending and LPA will forward findings to the Centralized Application Bureau (CAB) for final review and approval. CAB will further contact applicant on final status of application.

Exit interview conducted and a copy of this report was provided to the facility.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE: DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/15/2025
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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