191201966-9-20-2025-29-AS-ZCHN-DLQ74Y-20250920212042

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191201966
Report Date: 09/20/2025
Date Signed: 09/20/2025 09:24:30 PM

Document Has Been Signed on 09/20/2025 09:24 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	MOTION PICTURE & TELEVISION FUND		FACILITY NUMBER:	191201966
ADMINISTRATOR/ DIRECTOR:	LORENA SORIA		FACILITY TYPE:	740
ADDRESS:	23388 MULHOLLAND DRIVE		TELEPHONE:	(818) 876-1208
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91364
CAPACITY: 241		CENSUS: 158	DATE:	09/20/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:00 PM
MET WITH:	Martha Gutierrez, Nursing Manger, Maria Lopez, Dining Manager, and Anna Josue RN		TIME VISIT/ INSPECTION COMPLETED:	05:45 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) Zabel Chochian arrived at the facility today to conduct a required annual visit at approximately 1:00 P.M. Upon arrival LPA met with the Dining Manager Maria Lopez. LPA introduced self and reason for the visit was explained. Administrator, Lorena Soria, couldn’t be present at the time of the visit. The LPAs toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. At approximately 1:30 P.M., a tour of the physical plant was conducted with Maria Lopez. There are three separate residential areas for the licensed facility: Country House Cottages, Lodge, and Villa. The Cottages are for independent residents, the Lodge is assisted living, and the Villa consist of independent and assisted living residents. Required postings observed in the common areas of the facility. LPA inspected the common areas throughout the three buildings. These included the Country House library, activity rooms, and computer rooms. The areas were observed to be properly furnished and relatively clean at the time of the visit. Sanitizer observed available in all buildings. All three kitchens and dining room observed. Dining furniture was observed to be in good condition in each building. Knives and sharp objects observed to be kept inaccessible to residents in care. Kitchen appliances appeared to be in operable condition. LPA observed a sufficient supply of perishable and non-perishable food in each building. During the inspection, LPA observed the ice machine and dish washer in the Villa building inoperable. Staff reported that they are waiting for a part. Ice is brought from the other building and dishes are transferred as well to the other kitchen to be washed. LPA inspected eight (8) randomly selected bedrooms throughout the Cottages and The Lodge. The resident bedrooms were properly furnished and with sufficient lighting. (Continue to LIC809c)

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Zabel Chochian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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

FACILITY NAME: MOTION PICTURE & TELEVISION FUND	FACILITY NUMBER: 191201966
	VISIT DATE: 09/20/2025

NARRATIVE

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Hot water temperature was tested in eight randomly selected residents’ bedrooms. Hot water temperature measured within the required range of 105 - 120 degrees Fahrenheit. Resident bathrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels.

The facility maintained a comfortable temperature in each building. Smoke detector(s) and carbon monoxide detectors were operational at the time of the visit. Fire extinguishers were observed throughout the facility, fully charged and were last serviced 01/15/2025. Facility is gated. Entry/exits were free of obstructions. There are several shaded areas with adequate outdoor furniture for resident use. The outdoor areas were clean and free of hazards. No bodies of water noted at the time of the visit. There are two (2) buildings with staff offices, gym, and a pool for residents. Pool was locked and inaccessible to residents at the time of visit.

During the inspection the LPAs interviewed nine (9) residents and three staff members.

Due to time constraints annual inspection will continue on another date for records review, Villa building physical plant and medication procedures and policy review.

Exit interview conducted. Copy of report provided.

NAME OF LICENSING PROGRAM MANAGER: Desaree Perera
NAME OF LICENSING PROGRAM ANALYST: Zabel Chochian
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2025

LIC809 (FAS) - (06/04)

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