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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609856
Report Date: 07/19/2021
Date Signed: 07/19/2021 03:51:07 PM

Document Has Been Signed on 07/19/2021 03:51 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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:WESTFIELD SENIOR LIVINGFACILITY NUMBER:
197609856
ADMINISTRATOR:BALASANYAN, MARIAMFACILITY TYPE:
740
ADDRESS:7633 MASON AVETELEPHONE:
(818) 384-1134
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY: 6CENSUS: 5DATE:
07/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Alina AbraamyanTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced annual required visit. LPA met with facility staff and explained the reason for this visit. LPA spoke with administrator Mariam Balasanyan and explained the reason for this visit. Upon entry to the facility LPA's temperature was checked and some questions were answered regarding Covid-19.

A tour of the physical plant was conducted. The facility is licensed to service elderly residents. The facility has a fire clearance for six non-ambulatory residents, one of which may be bedridden in any room. The facility has six resident bedrooms designated for single occupancy. All rooms have direct exits to the outside. Resident rooms have appropriate lighting, furniture, bedding, and linens. LPA checked the kitchen for the ability to prepare and store food.

There are two bathrooms designated for resident use. The bathrooms are located in the hall. The bathrooms have a shower with grab bars where appropriate. There are no non-skid mats in the shower. The common areas were appropriately furnished and lighting was adequate. Facility had all the required postings up.

The facility smoke alarm system is hard wired and functional. There is one fire extinguisher in the kitchen area and one in the hallway. The fire extinguishers are fully charged and operational. There is a functional carbon monoxide detector in the hallway. The smoke alarm is also a carbon monoxide detector.

The exterior passageways were free of obstructions. There is a patio area at the back of the house with furniture appropriate for outdoor use. The back of the property is fenced or walled. There is a vehicle gate on the back of the house that is unlocked and connects to the back alley. The front of the property is fenced with a pedestrian gate for entry.
Exit Interview conducted.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2021
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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