197603746-4-9-2024-31-AS-NRED-D46SBC-20240409134343

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197603746
Report Date: 04/09/2024
Date Signed: 04/09/2024 01:43:52 PM

Document Has Been Signed on 04/09/2024 01:43 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.ASC, 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: 6	DATE:	04/09/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Rada Kigel		TIME COMPLETED:	01:20 PM

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At 8:20 a.m. on 04/09/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and later the administrator and disclosed the reason for the visit.

At 9:00 a.m. LPA conducted a record review of resident and personnel files. LPA and administrator toured the facility inside and out at 9:45 a.m.

The facility was last visited on 05/27/2023 for an annual inspection. It is a gated, single story building with five (05) bedrooms and four (04) bathrooms in the main building, one (01) additional bedroom and bathroom in a detached guest house, kitchen, common areas, tennis court, swimming pool, and outdoor areas. It has an approved fire clearance for six (06) bedridden residents. The facility serves residents with dementia. Approved hospice waivers for six (06).

At the main entrance, LPA observed postings for confidential complaint contacts, ombudsman contacts, facility license, administrator certificates, facility sketch, emergency disaster plan, personal rights, rights of resident councils, and neighborhood complaint procedures. A screening station containing a digital thermometer, gloves, masks, and a visitor log was located at the main entrance. Walls, floors, windows, screens, and blinds were clean and in good repair. At 9:45 a.m. LPA measured the room temperature to be 75.6 degrees Fahrenheit. Reading materials, board games, and exercise equipment were available.

The facility has six (06) bedrooms in total. One (01) bedroom is designated as a staff room. The staff room was locked and free of hazards. One (01) resident bedroom is shared and the rest are private. All bedrooms contained a chair, lamp, nightstand, storage, and a bed with adequate bedding. All furnishings were clean and in good condition.

The facility has five (05) bathrooms. All bathrooms contained liquid soap, paper towels, handwashing instruction sign, trash can with a lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At approximately 9:50 a.m. LPA measured the water temperature in the shared bathroom to be 115.6

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

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

FACILITY NAME: ROYAL GARDEN BOARD AND CARE II	FACILITY NUMBER: 197603746
	VISIT DATE: 04/09/2024

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degrees Fahrenheit.

LPA observed an adequate supply of perishable and non-perishable foods in the kitchen and pantry. Emergency supplies of food were observed in the pantry. The stove hood was clean. Appliances were in good condition. Sharps were locked in drawers. Cleaning solutions were locked below the sink. Medications were locked near the kitchen. LPA observed breakfast served around 9:00 a.m. and lunch served around 11:30 a.m.

A washing machine and dryer were located outside near the tennis court. Both were in working order. Detergents were locked in a nearby cabinet. Three (03) storage sheds containing extra supplies were locked. The tennis court was free of hazards. The swimming pool was gated, locked, and inaccessible. Covered patio areas were located in the front of the facility and immediately inside the second gate. The patio contained furniture in good condition. All emergency exit paths were free from obstructions. Exit gates were unlocked with self-closing latches. Four (04) out of four (04) auditory alarms were turned on and functioning. At approximately 10:00 a.m. smoke and carbon monoxide detectors were tested and operational. At approximately 10:10 a.m. LPA observed a fully charged fire extinguisher in the hallway. It was last inspected on 06/31/2023. At 10:15 a.m. the house telephone was called and operational.

During today's inspection, the facility was in compliance with Title 22 regulations. No immediate health and safety risks were observed.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

LIC809 (FAS) - (06/04)

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