197606676-6-10-2022-31-AS-MCAA-CF9T67-20220610142640

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197606676
Report Date: 06/10/2022
Date Signed: 06/10/2022 05:33:36 PM

Document Has Been Signed on 06/10/2022 05:33 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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	BROOKDALE GARDENS OF TARZANA		FACILITY NUMBER:	197606676
ADMINISTRATOR:	MNATSAKANYAN, LILIT		FACILITY TYPE:	740
ADDRESS:	18700 BURBANK BLVD		TELEPHONE:	(818) 342-0003
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	90	CENSUS: 47	DATE:	06/10/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:12 AM
MET WITH:	Meriam Gezalian		TIME COMPLETED:	02:30 PM

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Licensing Program Analysts (LPAs) MIchael Cava and Gary Tan conducted an unannounced annual inspection. LPA met with the Business Office Manager, Mariam Gezalian and disclosed the reason for the visit.

The facility has two (2) floors. The first floor contains resident rooms, the kitchen, dining room area, common space for activities, and outdoor patio that is furnished. The second floor contains resident rooms, beauty salon, medication room, an activity room and an outdoor patio that is also furnished. Floors are accessible through elevator and stair access.

At approximately 11:30 PM, LPAs toured the physical plant.

Entry: LPA observed 2 signs on the front door related to COVID-19 precautions for mask requirements and visitation.

Screening: LPAs were screened for symptoms of COVID-19 and had temperature taken upon entry to the facility. Facility maintains a log tracking visitors’ symptoms, names, and temperatures. When residents return from outings, staff conduct symptom checks and observe for any noticeable changes in condition. Facility uses rapid tests if residents are symptomatic.

PPE: Facility has a sufficient supply of PPEs

Bedrooms: The facility has a capacity of 90. Rooms that were inspected are private and have a private bathroom.

Bathrooms: Resident bathrooms were inspected and observed for compliance. The hot water termperature was measured between 105.5 to 109.1.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022

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: BROOKDALE GARDENS OF TARZANA	FACILITY NUMBER: 197606676
	VISIT DATE: 06/10/2022

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Kitchen and Dining Room Area: The kitchen and dining room area appeared clean, odorless, and free from debris. The dining room area has tables which are approximately 6 feet apart from each other.

Common Areas: The activity areas have chairs which appear to be in good repair. The facility has elevators, which had signs for masking requirements, coughing etiquette, and social distancing, LPA observed signs posted throughout hallways on all floors for social distancing, mask wearing, and cough etiquette.

Outside Space: LPA observed outdoor areas to be free from obstruction and hazards. All emergency exits on the first floor were unlocked and have sensors when opened. Outside patio areas were furnished.

Mitigation: Mitigation plan was approved 3/15/21. All residents are fully vaccinated with booster. Ms. Gezalian advised the LPA that meal times are only one seating due to low census. Distancing is maintained.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022

LIC809 (FAS) - (06/04)

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