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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610373
Report Date: 02/14/2025
Date Signed: 02/14/2025 02:45:58 PM

Document Has Been Signed on 02/14/2025 02:45 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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:WESTCLIFF RESIDENTIAL CAREFACILITY NUMBER:
197610373
ADMINISTRATOR/
DIRECTOR:		MANABAT, EILEENFACILITY TYPE:
740
ADDRESS:39949 WESTCLIFF STREETTELEPHONE:
(626) 487-5691
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY: 6CENSUS: 2DATE:
02/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Eileen ManabatTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced visit and was greeted by the Administrator Eileen Manabat. LPA stated the purpose of the visit was to conduct an annual inspection. The facility is licensed for a total of six bedridden/hospice residents. The Administrator confirmed there are two residents.

LPA Spaeth and the Administrator toured the location at 10:00 am until 10:30 am.

Common Areas – The living room was furnished with comfortable seating. The family room, kitchen, and dining room are combined. The family room contained comfortable seating and a television. The dining room section contained a dining room table & chairs.
Kitchen – LPA observed a two day supply of perishable food and a seven day supply of non-perishable food items. The knives were locked in a kitchen drawer. The cleaning solutions were locked underneath the kitchen sink. A fire extinguisher is located in the kitchen.

Hallway – The hallway closet was locked and contained the resident files, resident medications, resident hygiene items, and the first aid kit. Additional cleaning supplies were stored on the bottom of the closet

Laundry Room – The laundry room was locked and contained washer/dryer and laundry soap. A door leading to the garage was locked

Garage - LPA observed the garage was locked. The emergency food was stored in this location along with additional cleaning solutions.

Continued on 809-C

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: WESTCLIFF RESIDENTIAL CARE
FACILITY NUMBER: 197610373
VISIT DATE: 02/14/2025
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Bathrooms – There are two bathrooms in the facility which contained hand soap, paper towels, slip resistant mat, and a trash can.

Water Temperature - The temperature was tested at 10:30 am and was 107.0 degrees F.

Backyard - Comfortable outdoor seating is provided for the residents. The side gate leading from the backyard to the front yard was not locked.



Smoke/Carbon Monoxide Detectors – The smoke detectors and the carbon monoxide detectors were tested at 10:20 am and were operable.

LPA reviewed residents' records at 10:30 am until 11:00 am. LPA reviewed staff records at 11:00 am until 11:30 am. LPA reviewed resident medications at 11:55 am until 12:10 pm.

There are no deficiencies to report. The exit interview was conducted, and a copy of the signed report was given.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025
LIC809 (FAS) - (06/04)
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