195850289-9-19-2024-29-AS-TBYE-D99TRK-20240919145740

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850289
Report Date: 09/19/2024
Date Signed: 09/19/2024 02:58:35 PM

COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/19/2024 02:58 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	RADFORD HOME		FACILITY NUMBER:	195850289
ADMINISTRATOR/ DIRECTOR:	MATEVOSIAN, RAFAEL		FACILITY TYPE:	735
ADDRESS:	8016 RADFORD HOME		TELEPHONE:	(818) 522-2222
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91605
CAPACITY: 4		CENSUS: 4	DATE:	09/19/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:34 PM
MET WITH:	Rafael Matevosian		TIME VISIT/ INSPECTION COMPLETED:	03:05 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	Licensing Program Analyst (LPA) Trevor Byrne arrived at the facility unannounced to conduct a required annual visit at 12:34 PM. LPA met with facility operator Rafael Matevosian. Entrance interview conducted and the reason for the visit was explained. Beginning at 12:36 PM, the LPA, along with facility operator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: KITCHEN: The LPA observed the kitchen area to be clean. Kitchen appliances were in operable condition. The facility has a sufficient supply of two (2) days perishable and seven (7) days non-perishable food. LPA observed a secured drawer to contain knives and other sharp objects. The LPA observed a fire extinguisher to be fully charged and serviced on 05/10/2024. The LPA observed an emergency food bin to be located under the kitchen sink. BEDROOMS: There are four (4) bedrooms in the facility; three (3) are designated for resident use, and one (1) is designated as a staff bedroom. One (1) resident room is designated as a dual occupancy room. LPA and facility operator toured all four (4) rooms. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. All resident rooms contained flashlights for emergency use. The staff room was observed to be locked and inaccessible to clients in care. BATHROOMS: There are two (2) bathrooms at the facility that are designated for both resident and staff use. The bathrooms were observed to be clean and in good repair and were equipped with nonskid surfaces. Grab bars were observed in the shower and next to the toilet all were properly secured. The water temperature was measured at 116.6 degrees Fahrenheit which is in compliance with regulation. Report Continued on LIC 809-C

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: RADFORD HOME	FACILITY NUMBER: 195850289
	VISIT DATE: 09/19/2024

NARRATIVE

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COMMON AREAS: This includes the living room and dining room. LPA observed the living room to be clean and properly furnished at the time of the visit. The living room contains an appropriately screened fireplace. Smoke detectors and carbon monoxide detectors were tested at 02:00 PM and were functional at the time of the visit. The dining room was observed to be clean and in good repair. The dining room contains adequate seating for resident use. LPA observed the hallway of the facility to contain locked cabinets for resident’s personal use as well as an appropriately secured cabinet that contained laundry detergent and cleaning supplies. LPA observed a washer and dryer as well as adequate emergency water supplies in the facility hallway.

OUTDOOR SPACE: The facility has one (1) emergency exit gate, LPA observed clear passageways for emergency exit use. The facility has adequate shaded outdoor seating for resident use. The outdoor space contains a walkway to a residence at the back of the property that is not associated with the facility.

RECORD REVIEW: Record review began at 12:50 PM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, consent forms, and personal rights. Five (5) staff files were reviewed. All staff files contained the required documents and trainings. Four (4) resident files were reviewed. All resident files reviewed contained all required documentation. No deficiencies were observed during record review.

MEDICATION REVIEW / CASH RESOURCE REVIEW: Medication review began at 01:44 PM. Medications are stored centrally and securely in a storage cabinet in the hallway. Medications for two (2) residents were observed. All medications reviewed were documented properly on their centrally stored medication and destruction record sheet. No deficiencies were observed during medication review. Cash resources were reviewed for four (4) residents, all cash resources observed were documented properly with the corresponding receipts. No deficiencies were observed during cash resource review.

Report Continued on LIC 809-C

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: RADFORD HOME	FACILITY NUMBER: 195850289
	VISIT DATE: 09/19/2024

NARRATIVE

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INFECTION CONTROL / EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. The infection control plan was last reviewed on 05/31/2024. Last emergency disaster drill was conducted on 07/05/2024. The facility’s emergency disaster plan was updated on 09/03/2024 and is adequate.

INTERVIEWS: LPA interviewed two (2) staff members. No residents were interviewed due to them being out of the facility at a day program at the time of the visit. Both staff members interviewed were knowledgeable on their roles and responsibilities, the resident’s rights, the forms of abuse, and the appropriate reporting procedures for suspected abuse.

During today’s visit LPA obtained a copy of the facility’s updated LIC500, resident roster, surety bond, and liability insurance.

No deficiencies were cited at the time of the visit. Exit interview conducted. And a copy of the report was provided.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Trevor Byrne
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

LIC809 (FAS) - (06/04)

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