<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609518
Report Date: 03/12/2025
Date Signed: 03/12/2025 05:13:23 PM

Document Has Been Signed on 03/12/2025 05:13 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:BELMONT VILLAGE CALABASASFACILITY NUMBER:
197609518
ADMINISTRATOR/
DIRECTOR:		NELSON, NANCYFACILITY TYPE:
740
ADDRESS:24141 VENTURA BLVDTELEPHONE:
(818) 222-2600
CITY:CALABASASSTATE: CAZIP CODE:
91302
CAPACITY: 165CENSUS: 122DATE:
03/12/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Nancy NelsonTIME VISIT/
INSPECTION COMPLETED:
04:00 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 Analysts (LPA) Zabel Chochian arrived at this facility to conduct a required annual visit. At approximately 10:30 a.m., the LPA met with the Executive Director (ED), Nancy Nelson and reason for the visit was stated. Entrance checklist provided and reviewed with ED.

Between 11:15 a.m. and 1:45 p.m., the LPA and the ED toured the physical plant areas inside and outside to ensure there are no health and safety hazards and community is in compliance with Title 22 Regulations.
The facility is a three (3) story building. Resident rooms are located throughout three floors. The neighborhood (memory care unit) is located on the first (1st) floor; Circle of Friends units and assisted living units are located on the second (2nd) and third (3rd) floor. Common spaces on the first floor include the reception area/lobby, bistro, dining room, and fitness room. The remaining floors each have their common spaces for activities, and all are appropriately furnished. All activity rooms and common spaces appeared clean and in good repair. A theater and salon are located on the third (3rd) floor. Activity schedules are posted throughout the facility. There were no obstructions and/or tripping hazards throughout the facility. There are fire extinguishers throughout the facility, which were charged and last serviced 01/27/2025. Fire alarm/sprinkler system was tested last on 2/19/2024 and is scheduled for 3/24-25/2025.

Resident Units: The LPA, and ED toured twelve (12) randomly selected rooms throughout the community. Rooms were furnished with clean linens, appropriate furniture and sufficient lighting. Restrooms: The resident units and common area restrooms observed fully stocked with supplies. Restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The water temperature was tested throughout the visit including resident unit restrooms and public restrooms; and water measured between 117.0– 120.2 degrees Fahrenheit. Throughout the resident room tours, LPA interviewed four (4) residents.

Outside areas: There are multiple outdoor patios equipped with furniture for resident use as well as covered areas for resident use. The in-ground pool is appropriately fenced. (Continue to LIC809c).
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: BELMONT VILLAGE CALABASAS
FACILITY NUMBER: 197609518
VISIT DATE: 03/12/2025
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
26
27
28
29
30
31
32
Kitchen: Dining is located on the first floor and was observed to be clean and sanitary. The facility had a sufficient supply of two-day perishable and seven-day nonperishable food. The menu was available for viewing and the facility offers daily specials and a standard selection at every meal. Sufficient snacks and beverages observed. Facility is also stocked with sufficient emergency food and water supply. A digital system is used to capture residents prescribed diets, allergies, and food preferences.

Documentation obtained: Copy of the liability insurance, resident roster, staff roster (LIC500), Infection Control Plan, copy of menu, last dieticians report vehicle service record Emergency and Disaster Plan.

Due to time constraints, the LPA will return at a later date to review staff and resident records including medication procedures and record keeping.

No health and safety issues observed during today's visit.

Exit interview conducted and copy of the report was provided.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC809 (FAS) - (06/04)
Page: 2 of 2