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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608053
Report Date: 03/28/2023
Date Signed: 03/28/2023 04:50:50 PM

Document Has Been Signed on 03/28/2023 04:50 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:GREENWOODS RESIDENTIAL CARE, INC.FACILITY NUMBER:
197608053
ADMINISTRATOR:MARILEN M. BASAFACILITY TYPE:
735
ADDRESS:9606 GOTHIC AVETELEPHONE:
(818) 335-4143
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 6CENSUS: 6DATE:
03/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:MARILEN M. BASATIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility at 10:00 am. LPA was greeted by staff who granted access to the facility. The administrator Marilen Basa was contacted by staff and arrived later.

LPA conducted a tour of the physical plant at 11:32 am to ensure there are no health and safety hazards and
facility is in compliance with Title 22 Regulations.

Common areas were observed for the ability to safely serve the needs of residents. These included the living
room and dining room combination. 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.

LPA reviewed the food service areas, food storage and supply (perishable and nonperishable foods). The
kitchen food supply was observed and sufficient for the six (6) residents currently residing there. Two (2) days of perishable fruits, vegetables, milk, and eggs observed and 7 days non-perishable food observed. The freezer is stocked with meats and frozen vegetables. An adequate supply emergency food and water stored in hallway closet #1

Sharps are stored in a locked cabinet in kitchen. The residents medications are stored in locked
cabinet in kitchen observed to be inaccessible to residents. The first aid kit is readily available and stored
in kitchen cabinet with medications observed to be fully stocked. There are two (2) fire extinguishers in the kitchen observed to be charged.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2023
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: GREENWOODS RESIDENTIAL CARE, INC.
FACILITY NUMBER: 197608053
VISIT DATE: 03/28/2023
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(Cont . from 809)

Laundry area located in kitchen behind accordion styled doors. The appliances observed to be functional. Toxins stored in locked hallway closet #2 near kitchen was observed to be locked and inaccessible to residents.

The facility has a total of six (6) bedrooms: four (4) for residents/ two (2) for staff and two (2) bathrooms for
residents use.

The resident bedrooms were properly furnished with at least one chair, night stand, and sufficient lighting for
each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPA observed a sufficient supply of linens in storage cabinet in living room

Each bathroom has posted “wash your hands” signs and the following items available: hand soap, paper
towels, and trash cans. The hot water temperature was measured for the two (2) bathrooms to ensure it is
within the required range for residents’ comfort and safety. The water temperature range was between 123.7- and 109.0-degrees Fahrenheit.

There are three patio areas: One (1) uncovered patio in front yard and two (2) umbrella covered patios in the back yard. All patio areas included table, and chairs with sufficient seating for residents. Patio furniture observed to be in good repair.

Smoke detectors and Carbon Monoxide detector were tested and function properly

Facility grounds were free of hazards. There is no body of water in the facility. There were no immediate
health and safety hazard observed during the day of inspection.

Technical Violation: Change to physical plant.

Exit interview conducted and copy of report given.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023
LIC809 (FAS) - (06/04)
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