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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606270
Report Date: 11/19/2021
Date Signed: 11/19/2021 11:12:06 AM

Document Has Been Signed on 11/19/2021 11:12 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:DENOGEAN ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
197606270
ADMINISTRATOR:RICHARD W. DENOGEANFACILITY TYPE:
735
ADDRESS:10712 ARTRUDE STREETTELEPHONE:
(818) 353-8214
CITY:SHADOW HILLSSTATE: CAZIP CODE:
91040
CAPACITY: 4CENSUS: 4DATE:
11/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Richard DenogeanTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Tuesday Cabiness arrived at the facility to conduct an unannounced infection control inspection/visit. Upon entry, LPA was greeted by Administrator Richard Denogean, who allowed LPA to enter. LPA’s temperature was not taken upon entry, and there was no observation of a cleaning station, or sign-in/visitor record book available at the time of the visit. There have not been any active or past COVID cases at the facility, and (6) staff and (4) clients have been vaccinated. Currently, (3) staff have received the booster and (3) are waiting to be scheduled. Clients are scheduled for booster shot on December 03, 2021. The current census is (4). LPA observed staff to have full mask covering. The facility had minimal COVID-19 postings throughout the facility. LPA observed signs at the front door. LPA requested to the Administrator that more signs need to be visible throughout the facility and hand washing signs in all bathrooms, including the kitchen.

The infection control inspection began with the Administrator Richard. The facility's mitigation plan was submitted, but not fully reviewed or approved. LPA reviewed the mitigation plan, and requested more information to be included. The Administrator will resubmit. Information already provided will be accepted and approved during the visit. The facility is a single story home, that is divided, with an additional separate living quarter used for clients. LPA observed the property, and there are (2) shared rooms, and a private bathroom. The common areas were observed to be clean, including bathrooms, with soap and towels; but no hand washing signs. LPA conducted a mitigation plan review with the Administrator, to obtain further information that was missing in the initial report submitted. The facility has ceased COVID testing for clients and staff, since everyone is vaccinated and will be receiving the booster vaccine. But the facility has in-house testing kits available, if needed to test staff or clients. All new employee hires are required to be vaccinated before employment. Administration continues to conduct training to staff in relation to COVID-19. Administrator reported the facility receives departmental emails. There is paid sick leave policy in place.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2021
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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: DENOGEAN ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 197606270
VISIT DATE: 11/19/2021
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There is (1) single designated room for potential positive COVID clients. Facility has a sufficient supply of PPE. Currently, the facility has sufficient staff, and has contracted with an hiring agency if needed. Visiting is conducted outside on the patio; and visitors must show proof of vaccination and where a mask. Procedures are in place for clients when leaving and returning to the facility. The Administrator informed LPA that they continue to implement the best practices for their facility, which has kept them COVID-19 free. The continue to clean (3x) a day. The facility is aware to report any changes with clients and staff to Licensing and there LPA, pertaining to positive COVID-19 cases.

Exit interview was conducted with Administrator Richard.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
LIC809 (FAS) - (06/04)
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