197607629-12-3-2023-31-AS-GSAO-CY6RDK-20231203115605

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607629
Report Date: 12/03/2023
Date Signed: 12/03/2023 11:56:10 AM

Document Has Been Signed on 12/03/2023 11:56 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	RIDGEWOOD RESIDENTIAL CARE HOME #3		FACILITY NUMBER:	197607629
ADMINISTRATOR:	MARIA CRUZ		FACILITY TYPE:	740
ADDRESS:	19231 DEARBORN STREET		TELEPHONE:	(818) 626-9220
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91324
CAPACITY:	4	CENSUS: 3	DATE:	12/03/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Maria Cruz		TIME COMPLETED:	12:45 PM

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Licensing Program Analyst (LPA) Gina Saucedo conducted an unannounced Annual visit to this facility at 09:05am. LPA Saucedo was greeted by Staff (S1) . The purpose of the visit was discussed. S1 called the administrator upon my arrival. The administrator arrived 9:45am while waiting, the resident and staff rosters were obtained. The census was also provided.

LPA conducted a tour of the physical plant at 10:15 am. By the entrance of the facility there is signs displaying hand washing, coughing etiquette, physical distancing, Ombudsman.

Kitchen area was observed to be clean. LPA reviewed the food service area in the refrigerator, food storage and supply (perishable and nonperishable foods) were sufficient for several days. The kitchen food supply was observed and sufficient for the three (3) residents currently residing there. There is an excess of perishables in several of the cabinets with several canned goods. Sharps observed to be stored, locked, and secured in one of the cabinets next to the dishwasher, inaccessible to clients. The fire extinguisher is located in the kitchen area and is fully charged, reading June 2024.

Temperature of facility wall thermostat is observed and set to 69 degrees Fahrenheit.

Garage/Backyard area The garage is attached to the house and can be entered from the second hallway next to the third (3) bathroom. There is a supply of extra paper towels, water supply, PPE’s, wheelchairs, incontinence and wipes. There is an additional refrigerator with extra food. The laundry area is located in the garage with a washer and dryer. In the backyard, There is a dining area that has a covered patio which has sufficient seating for the three residents. There is a pool located in the backyard that is fenced and locked inaccessible to the residents.

LIC 809-C continued

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2023

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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: RIDGEWOOD RESIDENTIAL CARE HOME #3	FACILITY NUMBER: 197607629
	VISIT DATE: 12/03/2023

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There is a dining room which has a table where the residents can sit and use to eat. There is enough seating for three (3) residents.

The living room was observed to have adequate seating for residents. Administrator confirmed there are three (3) non-ambulatory, residents-two male and one female. There is internet, a television and a phone line for use. There is enough furnishings and enough lighting. The living area had furnishings and sufficient lighting. There is no fireplace.

Resident bedrooms: There are four (4) resident bedrooms, two staff bedrooms and three bathrooms. Bedroom three (3) is vacant. It is vacant but still has all furnishings, ready for use. Bedroom one (1), two (2) and three (3) are single, housed rooms with proper furnishings. The other two bedrooms were opened where staff sleep for observation. There is three bathrooms in the house which are accessible to the residents for use. The hot water temperature was measured for the three (3) bathrooms to ensure it is within the regulations. The water temperature of the bathrooms range between 109.9 and 106.2 degree Fahrenheit. The bathrooms had proper signs displaying proper hygiene. The bathrooms had proper supplies of toilet paper, napkins, grab bars and toilet was functioning properly.

There is carbon monoxide present in each room and function properly. The smoke detectors are also functioning properly.

The medication, chemicals and first aid are locked and secured in the cabinets next to the dining room area. There is also a first aid manual. There is extra linen in the cabinets located next to the dining room area.

Administrative: The Annual fee is current. There is additional signs in the living room area displaying the licensee certificate, Rights of the Individuals with Developmental Disabilities, Rights of Residents, YES postage, Daily Activity Schedule, Personal Rights, Facility sketch, Disaster Plan.

An exit interview was conducted, no citation issued, and a copy of this report was given to the Administrator.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4334
LICENSING EVALUATOR NAME: Gina Saucedo	TELEPHONE: (818) 304-3057
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2023

LIC809 (FAS) - (06/04)

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