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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850289
Report Date: 09/08/2023
Date Signed: 09/11/2023 08:42:25 AM

Document Has Been Signed on 09/11/2023 08:42 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:RADFORD HOMEFACILITY NUMBER:
195850289
ADMINISTRATOR:MATEVOSIAN, RAFAELFACILITY TYPE:
735
ADDRESS:8016 RADFORD HOMETELEPHONE:
(818) 522-2222
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91605
CAPACITY: 4CENSUS: 4DATE:
09/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:09 AM
MET WITH:Rafael MatevosianTIME COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual inspection at 09:45 a.m. LPA Urena spoke with administrator on the phone, due to no one was available at the facility at the time of arrival. LPA Urena met with administrator Rafael Matevosian and explained the reason for the visit.

The LPA and the administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The dining room furniture was observed to be in good condition. The LPA observed a fire extinguisher in the kitchen area to be fully charged and operational. The LPA observed sharp objects and toxins to be locked away and inaccessible from residents.

BEDROOMS: The LPA observed three residents’ bedrooms, which were furnished appropriately with clean linens, furnishings and sufficient lighting. Bedrooms #1,2, and 3, were occupied. Bedroom # 2 is double occupancy.

RESTROOMS: Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Bathrooms are sufficiently stocked with hand liquid soap and paper towels.

COMMON SPACES: In the common areas, walls, flooring and furniture were checked for cleanliness and were in good condition. Required postings were observed in the entryway. Exits had a functioning auditory device.

Cntinues on LIC 809C...

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2023
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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: RADFORD HOME
FACILITY NUMBER: 195850289
VISIT DATE: 09/08/2023
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OUTDOOR AREA: The LPA observed the backyard to be free of clutter and debris and observed outdoor patio/furniture and shade for residents’ use.

RECORDS: Records review began at …., Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order.

MEDICATIONS: Medications review began at 12:30 p.m.; medications are centrally stored and locked in a cabinet in the hallway next to bedroom #1; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review.

INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The LPA discussed the new PIN changes regarding infection control.

The LPA obtained the following documents:


- LIC500 Personnel Report
- LIC9020 Client Roster

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023
LIC809 (FAS) - (06/04)
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