197606676-6-19-2024-31-AS-NRED-D6DVQA-20240619163800

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197606676
Report Date: 06/19/2024
Date Signed: 06/19/2024 04:38:41 PM

Document Has Been Signed on 06/19/2024 04:38 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	BROOKDALE GARDENS OF TARZANA		FACILITY NUMBER:	197606676
ADMINISTRATOR:	HELEN LEE		FACILITY TYPE:	740
ADDRESS:	18700 BURBANK BLVD		TELEPHONE:	(818) 342-0003
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	90	CENSUS: 66	DATE:	06/19/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Logan Harrison		TIME COMPLETED:	04:45 PM

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At 9:00 a.m. on 06/19/2024, Licensing Program Analysts (LPAs) Nicholas Reed and Leizl delaCerra conducted an unannounced annual inspection. LPAs met with staff and later the Executive Director (ED) and disclosed the reason for the visit. LPAs and ED toured the facility inside and out.

The facility was last visited on 12/13/2023 for a case management visit. It is a two story building with eighty-three (83) private and shared bedrooms, private and shared bathrooms, kitchen, dining area, common areas, activity areas, exercise room, offices, beauty salon, theatre, laundry room, and outdoor areas. It has an approved fire clearance for ninety (90) nonambulatory residents. Approved hospice waivers for five (05).

A file review was conducted prior to this visit.

LPAs observed postings for confidential complaint contacts, Ombudsman contacts, emergency disaster plan, facility license and sketch, theft and loss policy, personal rights, and rights of resident councils near the mailboxes at the front. Additional postings were observed inside for a transportation schedule, activity schedules, and daily menus.

The parking lot is located in the rear of the facility. Surveillance cameras were placed on the exterior and in common areas. Exits are secured with keypad locks. At 10:00 a.m., approximately fifteen (15) residents were observed participating in exercise activities in the main activity area.

The facility has private and shared bedrooms. Bedrooms are furnished by residents and contain a chair, lamp, nightstand, storage, pull cords in the bedroom and bathroom, mini fridge, microwave, private bathrooms, and a bed with adequate bedding. All furnishings were clean and in good condition.

The facility has private and shared bathrooms. Private bathrooms in rooms contained liquid soap, paper towels, trash cans with a tight fitting lid, grab bars near the toilet and shower pull cords, and a non-skid surfaces in the shower. All shared bathrooms contained liquid soap, paper towels, handwashing instruction sign, trash can with a tight fitting lid, grab bars near the toilet, and pull cords.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BROOKDALE GARDENS OF TARZANA	FACILITY NUMBER: 197606676
	VISIT DATE: 06/19/2024

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At approximately 10:15 a.m. LPAs measured the room temperature to be 72 degrees Fahrenheit. Walls, floors, windows, screens, and blinds were clean and in good repair. The fireplace was appropriately covered. Hand sanitizer stations are posted throughout the facility on both floors. At approximately 10:30 a.m. LPAs observed fully charged fire extinguishers on the first and second floor hallways which were last inspected on 06/11/24. Flashlights were also placed in each fire extinguisher housing. At approximately 11:00 a.m., smoke and carbon monoxide detectors were tested and operational. At 11:13 a.m. and 11:35 a.m., call system pull cords were tested in Room #210 and Room #110. Staff responded within three (03) minutes each time. Between 11:15 a.m. and 11:35 a.m. LPAs measured water temperatures in first and second floor rooms to be 112.5, 106.5, and 119.0 degrees Fahrenheit. The upstairs gym contained exercise equipment in good condition. The Beauty Salon, electrical rooms, and storage closets containing cleaning supplies, PPE, and confidential files were all locked. The theatre contained movies, television, and furniture in good repair. Board games, puzzles, and reading materials were provided in both activity areas. A computer with internet, microphone, and camera was available for resident use on the first floor. Signs indicating “No Smoking – Oxygen in Use” were placed appropriately in hallways.

The facility uses secured medication carts on each floor to assist with medications. The medication room is locked and contained medical records and a complete first aid kit with tweezers, scissors, bandages, and digital thermometer.

LPA observed an adequate supply of perishable, non-perishable, and emergency foods and water in the kitchen. The stove hood was clean. Appliances were in good condition. Resident dietary cards were posted. At 11:51 a.m. and 11:53 a.m., walk-in refrigerator and freezer temperatures were measured to be 38 and -5 degrees Fahrenheit. The locked laundry room near the kitchen contained two (02) washing machines and two (02) dryers. Both were in working order.

LPAs observed two (02) covered patio areas in the rear of the facility. They contained furniture in good condition, gardened areas, a designated smoking area, self-locking exits, and a gas grill. All emergency exit paths were free from obstructions.

During today's inspection, the facility was in compliance with Title 22 regulations. No immediate health and safety risks were observed.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

LIC809 (FAS) - (06/04)

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