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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603977
Report Date: 03/18/2024
Date Signed: 03/18/2024 11:59:09 AM


Document Has Been Signed on 03/18/2024 11:59 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
WOODLAND HILLS N.ASC, 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: 5DATE:
03/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Rohangiz YadidiTIME COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Valeria Conway, Brittany Thomas and Kelly Dulek conducted an unannounced Case Management. LPAs met with administrator Rohangiz Yadidi upon arrival. Entrance interview conducted.
On 02/23/2024 LPAs conducted a random visit to the facility in which the decision in order was reviewed and a copy was given to the licensee. Also, LPAs instructed the licensee to post the stipulation and communicate with resident’s family and placement agencies. The Licensee was also instructed to issue a valid 60-day notice to all residents and their responsible parties.

During today’s visit, LPAs did a walkthrough of the physical plant and did not observe the accusations posted at the facility. Interviews conducted revealed that licensee only provided a change of ownership letter to some residents on different dates. Resident #1 (R1) stated that they didn’t know the Licensee is retiring nor did R1 receive a letter since last day Licensing visit the facility. Licensee stated that none of the residents nor their responsible parties have received the Accusations from the Licensee or the licensee's lawyer. During today's visit, LPAs interviewed administrator and inquired if residents and their responsible parties were informed via written notice of the 60-day letter and if LPAs can obtain a copy of the notice. Administrator stated that the families were notified verbally and via mail immediately, however LPAs observed the letter issued does not contain the required language and therefore needs to be reissued. Also, during today's visit, Licensee posted the decision in order and LPAs contacted the responsible parties for 3 of the residents to confirm if licensee/administrator notified them of the Departments served actions. Family members confirmed that they are not aware of the situation that the facility is going through and no formal letter was issued to communicate this matter. Families confirmed that they were not notified of the Accusations by the licensee/administrator.

Continued on LIC 809-C
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria ConwayTELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2024
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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: EDEN GARDEN "C", INC.
FACILITY NUMBER: 197603977
VISIT DATE: 03/18/2024
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Continued from LIC 809

Civil penalties shall be assessed against any facility which fails to take corrective action within described time periods. Per California Health and Safety Code section 1569.38, you are hereby notified that a $100 civil penalty per day will be assessed until the violation is corrected. This assessment will not exceed $100/day regardless of the number of notices the licensee fails to send. The total civil penalty for a continuous violation shall not exceed $5,000. Administrator was informed that on this day they were issued civil penalty in the amount of $3,700 dollars. The Accusation was served to the lawyer of the licensee on 01/31/2024.

You will receive an invoice in the mail. Payment is due when billed. Payment must be made by a personal, business or cashier’s check or money order made payable to the “California Department of Social Services”. Please write the facility number and invoice number on your check and include a copy of you invoice with the payment. You will find the invoice number on our invoice. DO NOT SEND CASH.



APPEAL RIGHTS

The applicant/licensee has a right without prejudice to discuss any disagreement concerning the
proper application of licensing laws and regulations with the licensing agency. When civil penalties are involved, the licensee may request a formal review by the licensing agency to amend, extend the due date, or to dismiss the penalty. Requests for civil penalty appeal must be in writing, must be postmarked within 10 days of receipt of this form, and must be addressed to the Regional Office or licensing office with jurisdiction over the facility. The agency has a duty to review the facts presented without prejudice within a 10-day period. Upon review of the facts upon which the appeal is based, the agency may amend any portion of the action taken or may dismiss the violation. The licensing agency review of the appeal may be conducted based upon information provided in writing by the licensee. The licensee may request an office interview to provide additional information. The licensee will be notified in writing of the results of the agency review. A copy of the Health and Safety code and a copy of Accusations were given to administrator during visit. California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, the following deficiencies are cited (Refer to LIC 809-D).

Exit Interview Conducted / Appeal Rights Discussed / A Copy of Report Issued
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria ConwayTELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/18/2024 11:59 AM - 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364


FACILITY NAME: EDEN GARDEN "C", INC.
FACILITY NUMBER: 197603977

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/19/2024
Section Cited
HSC
1569.38(b)(1)

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Posting of licensing reports; disclosure to new residents: (b) A licensed residential care facility for the elderly shall provide...events: (1) The department commences proceedings to suspend or revoke the license of the facility pursuant to Section 1569.50.
This requirement is not met as evidenced by:
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Lisensee posted stipulation during today's visit and agrees to deliver to each resident the 60-day letter approved by LPAs.
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Based on record review, and interviews LPA's obseverved that the Licensee failed to comply with the requirementst of posting the Stipulaiton timely and LPAs comfirmed with family members and licensee that 3rd parties were not notified. Which posses an immediate personal rights risk to residents.
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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: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria ConwayTELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2024
LIC809 (FAS) - (06/04)
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