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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610121
Report Date: 02/16/2022
Date Signed: 02/16/2022 03:06:04 PM

Document Has Been Signed on 02/16/2022 03:06 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:WEST HILLS ASSISTED LIVINGFACILITY NUMBER:
197610121
ADMINISTRATOR:MILLAN, JONATHANFACILITY TYPE:
740
ADDRESS:7055 SHOUP AVENUETELEPHONE:
(818) 883-7201
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY: 90CENSUS: 40DATE:
02/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jonathan MillanTIME COMPLETED:
02:30 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) Wendell Smith conducted an unannounced annual required visit. LPA met with administrator Jonathan Millan and explained the reason for this visit.

The facility is a two story building and has 1 working elevator and 2 stairwells. The roof is not accessible through the stairwells. LPA checked random resident bedrooms and bathrooms. All bedrooms and bathrooms were appropriately furnished.
Facility has an emergency generator and emergency supplies. The main kitchen and dining room are located on the 1st floor. The dining room and commercial kitchen were inspected and are in compliance with Title 22 Regulations. The facility has adequate nonperishable food and water supplies. Medications are centrally stored in the Medication room on the first floor, which has a refrigerator and complete first-aid kit. There are other additional first aid kits for each floor. There is a commercial laundry where staff wash towels and linens. The second floor contains a coin operated laundry room where residents wash clothing. There are several activity rooms, including two rooms on both the first and the second floors. Activity rooms are closed at this time due to COVID’19 mitigation measures. On the first floor, there are also two outdoor shaded areas where residents can conduct outdoor activities and utilize the garden. On the second floor, there is a large covered balcony.

The facility has no swimming pool or other bodies of water. This facility is Fire Cleared for 90 residents of which 15 may be bedridden. A hospice waiver has been approved for 30 residents.

Exit interview conducted

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2022
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 1