197603747-4-9-2024-31-AS-NRED-D46V4S-20240409160649

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197603747
Report Date: 04/09/2024
Date Signed: 04/09/2024 04:06:55 PM

Document Has Been Signed on 04/09/2024 04:06 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 & CARE III		FACILITY NUMBER:	197603747
ADMINISTRATOR:	RADA KIGEL		FACILITY TYPE:	740
ADDRESS:	5809 MELVIN AVENUE		TELEPHONE:	(818) 609-7763
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	6	CENSUS: 4	DATE:	04/09/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Rada Kigel		TIME COMPLETED:	04:10 PM

NARRATIVE

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At 1:15 p.m. on 04/09/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with the administrator and disclosed the reason for the visit.

LPA and administrator toured the facility inside and out at 1:20 p.m.

The facility was last visited on 05/27/2023 for an annual inspection. It is a gated, single story building with seven (07) bedrooms and eight (08) bathrooms, kitchen, common areas, 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 with evacuation routes clearly labelled, emergency disaster plan, personal rights, rights of resident councils, and neighborhood complaint procedures. A screening station containing a digital thermometer, hand sanitizer, masks, and a visitor log was located at the main entrance. Walls, floors, windows, screens, and blinds were clean and in good repair. At 1:25 p.m. LPA measured the room temperature to be 74 degrees Fahrenheit. Musical equipment, reading material, and exercise equipment were located outside and in the common areas.

The facility has seven (07) bedrooms in total. One (01) bedroom is designated as a staff room. The staff room was unlocked and free of hazards. All resident bedrooms are private. All bedrooms contained a chair, lamp, nightstand, storage, and a bed with adequate bedding. All furnishings were clean and in good condition. All exit doors were unlocked with auditory alarms on and functioning.

The facility has eight (08) 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 1:55 p.m. LPA measured the water temperature in the shared bathroom to be 110.1 degrees Fahrenheit.

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 & CARE III	FACILITY NUMBER: 197603747
	VISIT DATE: 04/09/2024

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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. Appliances were in good condition. Sharps were locked in drawers. Cleaning solutions were locked below the sink. Medications were locked above the counter tops.

A washing machine and dryer were located near the dining room. Both were in working order. Detergents were locked in a storage shed outside. Covered patio areas were located in the front of the facility in the rear. The patios contained furniture in good condition. All emergency exit paths were free from obstructions. At approximately 2: 05 p.m. LPA observed a fully charged fire extinguisher in the hallway. It was last inspected on 07/31/2023. At approximately 2:15 p.m. smoke and carbon monoxide detectors were tested and operational. At 2:25 p.m. the house telephone was called and operational.

At 3:00 p.m. LPA conducted a record review of resident and personnel files

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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