197606676-7-5-2023-31-AS-TSMH-CTG29D-20230705171146

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197606676
Report Date: 07/05/2023
Date Signed: 07/05/2023 05:11:51 PM

Document Has Been Signed on 07/05/2023 05:11 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:	HELEN LEE		FACILITY TYPE:	740
ADDRESS:	18700 BURBANK BLVD		TELEPHONE:	(818) 342-0003
CITY:	TARZANA	STATE: CA	ZIP CODE:	91356
CAPACITY:	90	CENSUS: 49	DATE:	07/05/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:07 AM
MET WITH:	Amanda Monroy		TIME COMPLETED:	05:17 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection in conjunction with a complaint visit at 10:07 am. LPA conducted a tour of the physical plant at approximately 11:25 am to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The facility has two (2) floors. The first floor contains resident rooms, Staff access only kitchen, dining room, great room, and furnished patio. The second floor contains resident rooms, theater, beauty salon, furnished veranda patio, medication room, and activity room. Floors are accessible by elevator and stair access. Common areas were observed for the ability to safely serve the needs of residents. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to be furnished appropriately with adequate seating for residents, clean and free from odors. LPA reviewed the food service areas, food storage and supply (perishable and nonperishable foods). The kitchen food supply was observed and sufficient for the forty-nine (49) residents currently residing there. Two (2) days of perishable food 7 days non-perishable food observed. The freezer and pantry rooms were stocked with meats and frozen vegetables. Sharps are stored in the locked kitchen area. Laundry room in hallway across from the kitchen. The appliances observed to be functional. Toxins stored in locked closets observed to be locked and inaccessible to residents. Medications are stored in two (2) locked medication carts and/are in the medication room.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023

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: 07/05/2023

NARRATIVE

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(Cont from 809)

The facility has a capacity of 90. A random sample of six (6) bedrooms private rooms with a private bathroom were inspected.

Resident bathrooms were inspected and observed for compliance. Each bathroom had the following items available: hand soap, paper towels, and trash cans. The hot water temperature was measured for the six (6) bathrooms to ensure it is within the required range for residents’ comfort and safety. The water temperature range was between 108.0 and 113.4-degrees Fahrenheit.

There are approximately six (6) fire extinguishers located throughout the facility. Each fire extinguisher observed to be attached to walls, charged, and stored with a flashlight.

Smoke detectors/carbon monoxide detector were tested and operable at time of visit.

Facility grounds were free of hazards. There were no immediate health and safety hazard observed during the day of inspection.

At approximately 1:10 pm, LPA reviewed a total of 10 (ten) random files: six (6) resident and four (4) staff files. Resident files included physicians’ assessment, services appraisals, admission agreements, and personal rights documentation. Staff files had current CPR/First aid including appropriate medication and caregiver training's.

LPA to return at a later time to complete staff and resident interviews as part of the annual inspection.

Exit interview conducted/ Copy of report emailed.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Tihesha Smith	TELEPHONE: 818-307-6280
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023

LIC809 (FAS) - (06/04)

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