191202140-5-4-2024-31-AS-RCOR-D4XATL-20240504003030

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191202140
Report Date: 05/03/2024
Date Signed: 05/04/2024 12:32:36 AM

Document Has Been Signed on 05/04/2024 12:32 AM - 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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	TOPANGA-WEST GUEST HOME		FACILITY NUMBER:	191202140
ADMINISTRATOR/ DIRECTOR:	GREGORY ERDOSI		FACILITY TYPE:	735
ADDRESS:	22115 ROSCOE BLVD		TELEPHONE:	(818) 884-8100
CITY:	CANOGA PARK	STATE: CA	ZIP CODE:	91304
CAPACITY: 78		CENSUS: 47	DATE:	05/03/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:20 AM
MET WITH:	Gregory Erdosi		TIME VISIT/ INSPECTION COMPLETED:	03:30 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	At 10:20am, on 05/03/24, Licensing Program Analysts (LPAs) Raymond Comer and Michael Cava arrived to conduct an unannounced annual facility inspection. LPAs met with Facility Administrator, Gregory Erdosi, and reason for the visit was discussed. Facility is Licensed as an Adult Residential Facility, servicing 70 Ambulatory and 8 Non-Ambulatory, Ages 18 through 59. Facility is a single-story building with a lobby, offices, (27) shared bedrooms with private bathrooms, two (2) public bathrooms, five (5) shower rooms, a library, two (2) laundry rooms, a medication room, kitchen, dining area, (2) recreation rooms, and an outdoor courtyard. The preferred language of the administrator is English. At 10:35 AM, LPAs conducted a tour of the physical plant with the Administrator and observed the following: RESIDENT RECORDS are stored in locked file cabinets in office area and inaccessible to residents. At 10:35am LPAs conducted a file review of resident records to ensure compliance of required documentation. Resident records are observed to be complete and current. STAFF RECORDS are stored in locked cabinets in office area and are inaccessible to residents. LPAs conducted a file review of Staff records to ensure forms and training are up to date and in compliance with licensing requirements. Staff records are observed to be complete and current. COMMON AREAS: All furnishing, fixtures, floors, windows, ceilings, and walls appear clean and in good condition. LIC 809C-continued

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024

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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: TOPANGA-WEST GUEST HOME	FACILITY NUMBER: 191202140
	VISIT DATE: 05/03/2024

NARRATIVE

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LIC 809C-continued

PHYSICAL PLANT was inspected for cleanliness and condition. Facility’s main door is the primary entry/exit access. Screening area is located immediately upon entrance. LPAs were greeted by Staff and given a temperature scan and protective masks to wear upon entering the Facility. Visitor Sign-in sheet, hand sanitizer, gloves and masks are available to all entrees. COVID safety, Hand washing, coughing etiquette, and other necessary signage are posted throughout the facility. Room temperature is comfortable; wall thermostat displays a setting of 73.0°F., within the required range. The facility has submitted an approved Mitigation and Infection Control plan approved on 12/25/2020. Required postings are prominently displayed and observed to be current at the facility. Disaster drills were last conducted on 4/13/2024.

KITCHEN area is clean and clear of clutter. Large sink, fixtures and appliances are functional. Knives/Sharps are securely stored, and inaccessible to residents. Refrigerated and frozen foods are stored at proper temperatures. A sufficient amount of perishable, and non-perishable food is present and properly stored. The facility menu appears to meet the daily dietary needs of the residents. Neither pesticides, nor poisons were observed near any food areas. Residents do not have access to the kitchen.

FIRE DETECTION/SUPPRESSION SYSTEMS are present at facility. Evacuation routes are clearly labelled and posted throughout the facility. Emergency exit routes were unlocked and free from obstruction. Facility maintains fire sprinklers in all hallways and rooms. Surveillance cameras are observed in hallways. The facility's smoke alarms are hard wired and tests are completed on a a monthly basis. Fire drill last conducted April 13, 2024. Fire extinguishers are observed throughout the facility and were last serviced on October 20, 2023.

MEDICATIONS: At 11:25 am, LPAs observed medication room which is secured and inaccessible to residents. Medication is locked in medication carts, properly labeled, and stored. Medication documentation appears to be complete. First aid kits were observed on each medication cart stored in the medication room.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024

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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: TOPANGA-WEST GUEST HOME	FACILITY NUMBER: 191202140
	VISIT DATE: 05/03/2024

NARRATIVE

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LIC 809C-continued

LAUNDRY: Facility maintains a laundry room which is located near the office area which is secured and locked. Washer and dryer machines are functional. Soaps, cleaning agents, and other chemicals are secured and inaccessible to residents. Linen storage area observed to have adequate supply of linen and towels.

BEDROOMS: Personal accommodations in resident bedrooms were observed for safety, privacy, and comfort. Random resident bedrooms were inspected and observed to contain properly furnished bedding, linens, at least one chair, night stand and sufficient lighting. Resident rooms contain signaling system pull cords and switches for assistance. Signaling system was tested and functions properly.

BATHROOMS were observed to be clean and sanitary with necessary supplies and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured at 113°F., Within the required range.

STORAGE: Janitorial storage near the laundry rooms, containing cleaning solutions and tools, are locked and inaccessible to residents.

OUTDOORS: At 12:15 pm, LPAs observed Outdoor courtyard to have a shaded patio, with tables and sufficient seating for residents. Patio furniture observed to be in serviceable condition. There are no bodies of water in the facility.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of this Report Issued.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024

LIC809 (FAS) - (06/04)

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