Facility Evaluation Report

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced case management visit and was greeted by the caregiver.

An Informal Meeting was conducted at the Woodland Hills Office on 9/17/2024 with the Licensee, Nicole De Las Alas. LPM Troy Agard discussed the deficiencies cited at the facility during an annual visit conducted on 08/07/2024. LPA Spaeth reviewed the deficiencies with the Licensee and informed the Licensee the deficiencies must be cleared by Tuesday, 9/24/2024.

Upon arrival, LPA explained the purpose of the visit was to review the residents' files and receive a copy of a staff member’s (S2) CPR/First Aid training certificate. LPA Spaeth received a copy during the visit

LPA toured the facility at 10:20 am until 10:55 am. At 10:45 am, LPA observed a bedridden resident was not in the designated bedridden room. At 11:00 am, LPA observed the auditory device on the front door and the exit doors to Rooms 2 and 5 were not working. LPA Spaeth reviewed the resident's files at 11:15 am until 12:00 pm. LPA observed five out of five residents' files were missing the I.D & Emergency Information form (LIC 601) and Personal Rights form. LPA also observed four out of the five residents are on hospice care. However the facility has an approved hospice waiver for three residents.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D).

Exit interview conducted, Appeal Rights discussed, and a copy of the signed report was given.