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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606270
Report Date: 11/21/2024
Date Signed: 11/21/2024 02:44:38 PM

Document Has Been Signed on 11/21/2024 02:44 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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:DENOGEAN ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
197606270
ADMINISTRATOR/
DIRECTOR:		RICHARD W. DENOGEANFACILITY TYPE:
735
ADDRESS:10712 ARTRUDE STREETTELEPHONE:
(818) 353-8214
CITY:SHADOW HILLSSTATE: CAZIP CODE:
91040
CAPACITY: 4CENSUS: 4DATE:
11/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Richard Denogean, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 11/21/2024 10:30AM Licensing Program Analyst (LPA) de la Cerra arrived at the facility listed above to conduct an unannounced annual inspection. LPA was greeted by caregiver, Eny. Administrator was contacted and arrived within half hour. LPA explained to the administrator the reason for the visit.

At approximately 11:00AM LPA and the administrator toured the physical plant of the facility, and the following was observed. This is an Adult Residential Facility (ARF), with an approved fire clearance for four (4)non-ambulatory clients. This facility consist of the main house area and the client living area. These 2 areas are connected by the staff member's bedroom which leads to the kitchen area of the main house.
The client's living area consist of two bedrooms, 1 bathroom and and a common area. LPA observed that the client living area is accessible through four separate entryways which have ramps free from obstructions.

Kitchens: The main area kitchen where clients meals are prepared was observed to be clean. Appliances were clean and functional. LPA observed a sufficient amount of 2-day perishable and 7-day non-perishable supply of food and were properly stored. LPA observed knives kept in a locked cabinet. The client kitchen has a refrigerator. Trash bins in both areas had covered lids

Common Areas: The facility has two(2) living rooms available for client use. Both living rooms were clean and properly furnished.

Bathrooms: There is one bathroom specifically designated for clients to use in the client's living area. The client bathroom is specifically designed for a non-ambulatory person and LPA observed the functional and appropriate fixtures.The LPA measured the hot water temperature in the client bathroom and temperature read between 106.5 degrees Fahrenheit and 110.2 degrees Fahrenheit, which is within regulation.

Continued on to LIC809-C
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: DENOGEAN ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 197606270
VISIT DATE: 11/21/2024
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Bedrooms: There are two bedrooms designated for clients use. Both rooms are designed for double occupancy and for non-ambulatory clients and include built in lifts for the beds. The rooms were appropriately furnished and had proper bedding.

Surrounding grounds: The front yard is well manicured and landscaped. There are ramps available for client use to access the house. The backyard is extensive and includes a patio with available shade for clients. No bodies of water observed. LPA observed all ramps surrounding the client's living area free from obstructions.

LPA observed the smoke and carbon monoxide alarms hardwired and interconnected. Administrator tested teh smoke and carbon monoxide alarms at 2:00PM and observed to function properly. Fire extinguisher was fully charged and recently inspected on 03/27/2024. LPA observed required facility postings in the clients living area The first aid kit was complete. Client medications and facility files are in a locked cabinet located in the client's living area. LPA observed the facility telephone in the common are and is operational. Temperature inside the client's area is set at 72°F and observed to be within the required range.

Fire extinguisher. The fire extinguisher is located in the dining area and was last checked on 02/04/2019. Extinguisher was observed to be operable and current. Smoke and carbon monoxide alarms hardwired and interconnected.

Facility Records: At 12:45PM LPA conducted records review of facility staff and clients. LPA reviewed four (4) out four (4) client records and four (4) staff records were reviewed to insure compliance.



Medications: At approximately 1:45PM medications and medication records were reviewed for proper documentation. Centrally Stored Medication Records are pre-filled by pharmacy and facility keeps a Medication Administration Record (MAR).

Administrative: LPA collected a copy of Certificate of Liability Insurance effective until 11/09/25, copy of Surety Bond effective until March 2025, LIC500 and LIC9020.

No deficiencies cited during today's visit. Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC809 (FAS) - (06/04)
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