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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850240
Report Date: 08/06/2024
Date Signed: 08/06/2024 11:41:05 AM

Document Has Been Signed on 08/06/2024 11:41 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:VARIEL OF WOODLAND HILLS, THEFACILITY NUMBER:
195850240
ADMINISTRATOR/
DIRECTOR:		JOYCE AQUINOFACILITY TYPE:
740
ADDRESS:6233 VARIEL AVETELEPHONE:
(818) 651-6018
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY: 436CENSUS: 356DATE:
08/06/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Jessica SaksTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Angela Barutyan and Trevor Byrne Barutyan arrived at the facility unannounced to conduct a Case Management - Annual Continuation visit at 9:10AM continuing the inspection that began on 07/11/2024. LPAs met with Director of Nursing Jessica Saks and Director of Compliance Angel Ascencio and explained the purpose of the visit.

RECORD REVIEW: LPAs began record review at 09:40AM. LPAs reviewed 10 (ten) staff files for documents including, but not limited to: health assessments, criminal record clearances, first aid/CPR training, and appropriate trainings. Personnel files reviewed were complete and were observed to be in compliance.

MEDICATION REVIEW: Medication review began at 11:03AM. Medications are locked and centrally stored in the wellness center office and the memory care director office. Medications for 5 (five) residents were reviewed and all are labeled and maintained in compliance with label instructions, and state and federal law.

INTERVIEWS: During today’s visit, LPAs interviewed 5 (five) staff between 10:39AM-10:54AM.

At 11:00AM, LPAs conducted a brief physical plant tour to ensure there are no health and safety hazards.

No deficiencies cited at this time. Exit interview conducted. A copy of the report of provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE: DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2024
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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