197603746-4-29-2022-31-AS-MCAA-CDXNUE-20220429104614

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197603746
Report Date: 04/29/2022
Date Signed: 04/29/2022 10:46:56 AM

Document Has Been Signed on 04/29/2022 10:46 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	ROYAL GARDEN BOARD AND CARE II		FACILITY NUMBER:	197603746
ADMINISTRATOR:	RADA KIGEL		FACILITY TYPE:	740
ADDRESS:	5909 MELVIN AVENUE		TELEPHONE:	(818) 609-7753
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	6	CENSUS: 4	DATE:	04/29/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Alexander Kigel		TIME COMPLETED:	11:00 AM

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Licensing Program Analyst (LPA) Michael Cava conducted a Required Annual infection control inspection. Upon arrival of the facility, LPA observed a large courtyard with patio furnishings for residents to sit outside, and a swimming pool, which was locked and secured. The pool is fenced all around and at least five feet high. LPA observed a padlock at the gate of the pool and inspected the lock to insure it was secured. LPA met with the administrator, Alexander Kigel and staff, Jennifer Haddon. LPA observed one resident in the living room watching tv and three residents in their room. Currently there was 1 staff, Jennifer Haddon, and the administrator on duty. Licensee Sophia Labendze was notified over the telephone. Personnel summary was verified; staff was cleared to work. The current census is (4).

A physical plant tour of the facility inside and outside was conducted with the administrator. The following common areas: living, dining, kitchen, resident bedrooms, and bathrooms, and guest house, was inspected to ensure the facility was in compliance with Title 22 Regulations:

Kitchen: Food service area had Licensing requirement of (7) day nonperishable, and (2) day perishable. Food was properly stored in a healthy manner. Frozen foods were properly wrapped and stored appropriately. There was a pantry, stocked with non-perishable, and an extra refrigerator with perishable items, located in a storage shed outside of the facility. Food storage and preparation areas were clean and inaccessible to pests and toxins. Appliances were functional and clean. Chemicals, household supplies, and knives, and medication, was locked and stored in kitchen cabinets. Living/dining/family/guest house: All indoor passageways were free from obstruction; inside temperature was comfortable and set to at least 75 degrees. All areas were clean and appropriately furnished for resident’s comfort.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ROYAL GARDEN BOARD AND CARE II	FACILITY NUMBER: 197603746
	VISIT DATE: 04/29/2022

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Bedrooms: The facility has (5) bedrooms; with (1) room designated for staff. All bedrooms were properly furnished and supplied with appropriate bedding and linens. Rooms observed to have bedspread, sheets, pillowcase, mattress pad, and blankets, which were in good repair. There were sufficient linens observed and available.

Bathrooms: There are (3); all were clean, with soap and towels, grab bars, and non-skid mats. Hot water measured in resident’s bathroom was measured at 120 degrees Fahrenheit.

Surrounding Grounds: There were no visible hazards, and passageways were free from obstruction. There is a covered patio with appropriate seating for residents, in the front courtyard by the swimming pool. Swimming pools was locked and secured. There is a detached guest house, that was inspected and empty. There were additional storage buildings at the back of the home designated for facility supplies and staff's personal items. Storage areas were observed and pose no immediate threat. Smoke alarms and carbon monoxide detectors were functional. Alarms are battery operated. Fire extinguishers are fully charged. The charge date is 06/21/21. First aid kit furnished fully equipped. All exit doors have alarms; all were operating.

Pursuant to title 22, division 6, chapter 8, there was no immediate health and safety hazard observed at this time. The administrator was advised and a copy of this report given.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022

LIC809 (FAS) - (06/04)

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