197603977-7-19-2021-29-AS-ASMH-C53S4M-20210719133259

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197603977
Report Date: 07/19/2021
Date Signed: 07/19/2021 01:33:25 PM

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	EDEN GARDEN "C", INC.		FACILITY NUMBER:	197603977
ADMINISTRATOR:	YADIDI, ROHANGIZ		FACILITY TYPE:	740
ADDRESS:	23601 CANZONET ST.		TELEPHONE:	(818) 348-2308
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91367
CAPACITY:	6	CENSUS: 6	DATE:	07/19/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Rohangiz ‘Rose’ Yadidi		TIME COMPLETED:	01:45 PM

NARRATIVE

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Licensing Program Analyst (LPA) Ashley Smith arrived at the facility unannounced to conduct a required annual visit at 12:00m. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Administrator Rohangiz ‘Rose’ Yadidi and explained the reason for the visit.

The LPAs 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: Knives, chemicals, and medications are stored in a locked cabinet in the kitchen. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, furnishings and sufficient lighting. RESTROOMS: Restrooms are clean, sanitary and in operating condition with grab bars and non-skid surfaces. During today’s visit, the LPA observed that the restrooms needed paper towels. The Administrator added paper towels during today’s visit. COMMON SPACES: Walls and flooring were checked for cleanliness and good condition. The LPA observed all the required postings in the common living space. During today's visit, the Administrator printed and posted the Department Provider Information Notices (PINs).

INFECTION CONTROL: The LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the LPA was unable to observe a central entry point for symptom screening, temperature checks, and sanitation station. However, interviews with staff and residents confirmed that the facility previously implemented this policy but recently stopped this. The LPA advised the Administrator to continue this practice, considering the rising cases of COVID positives from both vaccinated and unvaccinated individuals.

CONT 809-C

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: EDEN GARDEN "C", INC.	FACILITY NUMBER: 197603977
	VISIT DATE: 07/19/2021

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The LPA observed appropriate signs related to hand-washing, coughing etiquette, symptom checking, and physical distancing. Appropriate signs was also observed in the restroom regarding hand-washing techniques. The LPA observed an adequate supply of Personal Protection Equipment (PPE), yet the Administrator inquired about additional gloves. 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. This facility has not had a positive case of COVID-19 at the time of the visit.

The LPA conducted interviews with staff and residents regarding the facility’s protocol around visitation, specifically the visitation protocol from November 2020 – present. Interviews revealed that the facility complied with the directives given by the Department and the California Department of Public Health as it related to visitation. Regarding protocol around visitation in November 2020, it was communicated that visitation was limited to outdoor gatherings only, and interviews confirmed that visitation took place during appropriate business hours. Interviews also confirmed that visitors were screened, and temperatures were checked prior to seeing residents at this facility. Lastly, if residents left the facility, proper screening and temperature checking was conducted. As of today, residents confirmed that they are able to have visitors.

The facility’s policies and procedures as it pertains to infection control are adequate.

Recommendations included:

- Identify a central entry point for symptom screening, temperature checks, and sanitation station for visitors

- Continue to check and document temperatures of staff and residents daily. Continue daily symptom screening
- Posting Provider Information Notices (PINs) and educating staff, residents, and families on changing policies and procedures from the Department.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D):

Exit interview conducted, today's reports and appeal rights were reviewed and issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: EDEN GARDEN "C", INC.	FACILITY NUMBER: 197603977
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/19/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87468.1(a)(2)

Personal Rights of Residents in all Facilities

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above, as the LPA could not identify a central entry point for temperature check, signing in, and symptom screening, which poses a potential personal rights risk to persons in care.
	POC Due Date: 07/21/2021
	Plan of Correction
1 2 3 4	The Administrator has agreed to do the following: 1. The Administrator confirmed that they would continue this practice, as they stopped doing this some time ago. Administrator verbally confirmed that they would implement the practice. Plan of Correction met.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2021

LIC809 (FAS) - (06/04)

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