191202140-4-30-2025-31-AS-PKHN-DG8T4G-20250430142354

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191202140
Report Date: 04/30/2025
Date Signed: 04/30/2025 02:24:26 PM

Document Has Been Signed on 04/30/2025 02:24 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.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: 52	DATE:	04/30/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Gregory Erdosi- Administrator		TIME VISIT/ INSPECTION COMPLETED:	01:50 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	On 4/30/2025, Licensing Program Analysts (LPAs) Perchui Milena Khurshudyan and Angela Panushkina arrived at this facility to conduct a required Annual Inspection. Upon arrival LPAs were greeted by the Assistant Administrator Sanchez Rebecca, who granted access to the facility. LPAs introduced themselves by showing department badges and explained the reason for the visit. LPAs reviewed the required postings on a wall throughout the facility. The facility Administrator Gregory Erdosi arrived shortly after and assisted with physical plant tour throughout the facility and clients/staff files. The inspection tool was used to complete today's visit. At 9:55am. LPAs began a physical plant tour of the facility, and the following was observed: This is a single-story building with twenty-seven (27) shared bedrooms with private bathrooms, of which only four (4) bedrooms also have private showers. Bedrooms are appropriately furnished and have appropriate lighting. LPAs also observed two (2) public bathrooms, five (5) shower rooms, kitchen, dining room, medication room, recreation room, laundry room, library, tv/resting room, outdoor courtyard. Emergency exit plans were posted in each room and throughout the facility. Emergency exit plan’s had current location and exit routes labeled clearly. Facility has an approved fire clearance for seventy-eight (78) Non-ambulatory clients ages 18-59. Kitchen: LPAs observed a dining and kitchen area generally cleaned and organized. LPAs were informed that no food gets prepared in this location, and everything is being transferred from skilled nursing facility that is also part of the same management company. Facility Provides three (3) nutritious meals and snacks in between; menu was also available and posted in the dining area. LPAs observed a fire extinguishers in the kitchen and dining area, also throughout the facility. All eight (8) fire extinguishers were last served on September 16^th, 2024. Continue on LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Perchui Khurshudyan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: 04/30/2025

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Bathrooms: LPAs observed men’s, women’s, and staff bathrooms. All bathrooms contained fully stocked liquid soap and trash cans. The hot water measured between 106.2 – 107.8°F. Smoke detectors/carbon monoxide and fire sprinklers are located throughout the facility and are hardwired. A fire alarm initial test was conducted by LAFD on 3/6/2025.

Laundry Room: There are two washers and dryers available. All laundry appliances appear to be in a good condition. At 10:50am, LPAs observed all chemicals and detergents are kept locked and inaccessible to clients in care.

Outdoor area: The exterior passageways were clean and clear of any obstructions. LPAs observed a clean covered patio and backyard furniture to accommodate clients in care. There are no bodies of water on the premises. LPAs discussed the importance of maintaining the care and supervision to meet the needs of clients.

Between 11:30am to 1:00pm, LPAs reviewed records of ten (10) clients and three (3) staff. Clients and staff records appeared to be complete and updated. Client’s files contain signed admission agreements and a medical assessment, and all other required documentarians.
LPA collected Certificate of Liability Insurance, LIC500, LIC 9020, and Fire Alarm test.

No citations issued during this visit.
Exit interview conducted and copy of this report signed and delivered.

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Perchui Khurshudyan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2025

LIC809 (FAS) - (06/04)

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