197608054-2-21-2023-31-AS-ERIS-CP9QBY-20230221110219

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608054
Report Date: 02/21/2023
Date Signed: 02/21/2023 11:02:35 AM

Document Has Been Signed on 02/21/2023 11:02 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	RIDGEWOOD RESIDENTIAL CARE HOME #4		FACILITY NUMBER:	197608054
ADMINISTRATOR:	MARIA ROWENA B. CRUZ		FACILITY TYPE:	735
ADDRESS:	17245 EXETER PLACE		TELEPHONE:	(818) 866-6750
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY: 4		CENSUS: 4	DATE:	02/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:39 AM
MET WITH:	Karla Plata		TIME COMPLETED:	11:15 AM

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On 02/21/2023 at 9:39 a.m. Licensing Program Analyst (LPA), Evelin Rios, conducted an unannounced annual inspection / infection control visit at the facility mentioned above. LPA was greeted by staff member (S1), who granted access to the facility. Administrator's assistant Karla Plata arrived at 9:50 a.m. and LPA explained the reason for the visit. Administrator Maria Rowena Cruz could not attend todays visit and designated Karla to sign today's report.

At 9:50 a.m. physical tour was conducted with Karla and LPA and they observed the following:

Infection control: LPA reviewed the facility mitigation plan approved on 04/11/2021 and noted infection control plan was filed 06/17/2022. Upon arrival, LPA was screened and temperature was taken by S1. When Karla arrived she directed LPA to sign in. Proper infection control signs were observed inside along the hallway. Hand sanitizer, masks and gloves were observed in a cart upon entry. Karla stated they have sufficient PPE supplies for residents and staff.

Bedrooms: There are six (6) total bedrooms four (4) are designated for residents use and have sufficient lighting. All residents' bedrooms are properly furnished, clean and have appropriate bedding and linens. Auditory alarms were tested and observed to be operational.

Bathrooms: There are two (2) bathroom available for resident use. LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet paper, soap and paper towels. LPA observed appropriate hand washing signs posted in each bathroom. All trash cans in bathrooms had fitted lids to protect from cross contamination. At 10:25 a.m. LPA observed hot water temperature at 118.7 degrees Fahrenheit.

(Continue on LIC809-C)

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023

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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: RIDGEWOOD RESIDENTIAL CARE HOME #4	FACILITY NUMBER: 197608054
	VISIT DATE: 02/21/2023

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Medications/Resident files: LPA observed medications are centrally stored and locked in a cabinet, in the office along with resident files. All knives and sharps were also observed to be locked in a filing cabinet and inaccessible to residents in care.

Garage: Laundry area is located in an attached garage and kept locked and inaccessible to clients. Extra PPE supplies, extra food and cleaning chemical were also observed.

Kitchen: LPA toured the kitchen area was observed to be clean and clear of clutter. LPA observed enough 7-days non-perishable and 2-days perishable food supply at the facility.

Common Areas: The facility maintains a comfortable temperature at 74°F. The living room and dining area were observed to be clean and were properly furnished. No obstructions and or tripping hazards were observed on todays visit. There is a fire extinguisher by the dining area with purchased date of 06/15/2022 observed to be fully charged.

Smoke detectors/carbon monoxide: Smoke detectors are interconnected and were tested at 10:05 a.m. LPA observed smoke detectors to be functioning properly. LPA observed carbon monoxide detectors located in each resident room and were tested and observed to be operational.

Outside areas: LPA observed appropriate outdoor furniture, with a covered shaded area for clients. Side gate was unlocked and open. There are no bodies of water.

No citations issued during this visit. Exit interview conducted. Copy of this report provided.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023

LIC809 (FAS) - (06/04)

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