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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603977
Report Date: 01/11/2023
Date Signed: 01/11/2023 12:10:45 PM


Document Has Been Signed on 01/11/2023 12:10 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:EDEN GARDEN "C", INC.FACILITY NUMBER:
197603977
ADMINISTRATOR:YADIDI, ROHANGIZFACILITY TYPE:
740
ADDRESS:23601 CANZONET ST.TELEPHONE:
(818) 348-2308
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:6CENSUS: 6DATE:
01/11/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Rohangiz 'Rose' YadidiTIME COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elsie Campos conducted an unannounced Case Management visit to the facility today with the purposes of conducting a health and safety check. The LPA met with Administrator Rose Yadidi and explained the reason for the visit. There were three staff and six residents present.

During today’s visit, a physical plant tour was conducted. At 9:17 a.m., the LPA observed that the wall in the living room above the sliding door had water damage due to the excessive amount of rain that began at the beginning of the month. The administrator communicated that the exterior awning that is attached to the house had a leak that caused the damage and has since been repaired. The LPA observed that the exterior awning had been repaired preventing any future leaks. Administrator confirmed that arrangements have already been made to repair the interior. The LPA observed a repairman arrive at the facilty at 12:00 p.m. At 9:19 a.m. the LPA observed the wall in Bedroom # 2 had been damaged due to a circuit short from a personal heater. The administrator confirmed that arrangements are in place to have the wall fixed today. A repairman was observed to arrive at the facility to make those repairs. At 9:20 a.m. the LPA observed the flooring in Bedroom #1 had lifted and needed to be repaired. At 9:25 a.m. the LPA observed clutter against the exterior pathways were obstructed with a mattress, old furniture, wheelchairs, desk, chairs that need to be cleared to prevent a tripping hazard to exit areas. At 9:22 a.m. the LPA observed a person in the backyard who appeared to be residing outdoors. The administrator confirmed that this person had been sleeping in the backyard and had been asked to leave numerous times but was also Staff #1 (S1). The administrator asked the LPA to confirm if S1 was cleared and associated for employment. The LPA confirmed that S1 is associated to the facility. The LPA communicated to the administrator that staff cannot sleep in common areas and appropriate sleeping arrangements must be made.

Pursuant to Title 22 Division 6 Chapter 8 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 emailed to the Administrator.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie CamposTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 01/11/2023 12:10 PM - It Cannot Be Edited

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: 01/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/13/2023
Section Cited

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85087(a)(3) Buildings and Grounds (a) In addition to Section 80087, bedrooms must meet, at a minimum, the following requirements: (3) No room commonly used for other purposes shall be used as a bedroom for any person. This requirement was not met as evidenced by:
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The Administrator agreed to do the following:
1. Establish appropriate accommodations for staff as they are not to use the outdoor patio as a sleeping quarters and submit a plan of action regarding staff accomodations. Submit to CCL no later than 1/13/2023.
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Based on interviews and observation the licensee did not comply with the section cited above as Staff were found to be living outdoors, which poses a potential health and safety risk to persons in care.
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Type B
01/27/2023
Section Cited

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87307(d)(6) Personal Accommodations and Services. The following space and safety provisions shall apply to all facilities: All outdoor and indoor passageways and stairways shall be kept free of obstruction
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The Administrator agreed to do the following:
1. Clear all outdoor debris, trash and unused furniture such as mattress, wheelchairs, chairs, bedframes and submit to CCL by 1/27/2023.
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Based on observation, the licensee did not comply with the section cited above as they had furniture clutter surrounding the exterior perimeter, which poses a potential health and safety risk to residents in care.
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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 PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie CamposTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2