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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608054
Report Date: 01/17/2024
Date Signed: 01/17/2024 11:17:30 AM

Document Has Been Signed on 01/17/2024 11:17 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 #4FACILITY NUMBER:
197608054
ADMINISTRATOR:MARIA ROWENA B. CRUZFACILITY TYPE:
735
ADDRESS:17245 EXETER PLACETELEPHONE:
(818) 866-6750
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 4CENSUS: 4DATE:
01/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Karla PlataTIME COMPLETED:
11:45 AM
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On 01/17/24 at 08:55 AM, Licensing Program Analyst (LPA) Gina Saucedo, arrived to conduct an unannounced, annual inspection at the facility. Upon arrival, LPA Saucedo met with the Assistant Administrator- Karla Plata and disclosed the purpose of the visit.


LPA asked for the census, client, and staff rosters. There are four (4) male, non-verbal clients.

A physical tour was conducted at 09:45 AM and observed the following:

Kitchen area was sufficiently stocked with seven (7) days of perishable and seven (7) days of non-perishable food. There is one refrigerator in the kitchen area that is fully charged and date June 2023. The cabinets have canned goods with dates labeled on them. There is one telephone line that is located on the kitchen counter.

Living and dining room furniture is accessible for four (4) clients. There is a television and enough seating for four (4) clients. Furniture was observed to be in good condition. There is no fireplace in the facility. There are smoke detectors all around the house. The smoke detectors are hardwired and interconnected and were tested. The facility temperature at 70 degrees Fahrenheit. There is extra linen located in a pantry door that is located in the living room area.

Outside/Backyard: There is a backyard accessible to the clients for use with proper seating. The facility has a signal system. There is no pool/bodies of water.

809C-continued

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2024
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 #4
FACILITY NUMBER: 197608054
VISIT DATE: 01/17/2024
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Bedrooms: There are six (6) bedrooms. Four (4) of the bedrooms is single, occupied and for clients. The other two (2) bedrooms are for staff. All bedrooms were toured and were properly furnished and have appropriate bedding and linens. There are two (2) bathrooms for client and staff use. One by the dining/living room area. The other bathroom is located in the hallway in between the client rooms. The bathrooms have proper toiletry and grab bars. The bathroom temperatures of the water are within regulations reading at 111-112 degree Fahrenheit. There are carbon monoxide detectors in each room.

The medication is kept locked and secured in one of the cabinet areas in the staff office. The sharps are also locked and secured in of the cabinet areas in the staff office. There is another telephone line located in the staff office. The YES sign, house rules, daily activity schedule, personal and client roster and the disaster plan located against the wall in the staff office.

There is a garage that is accessible through the dining/living room area. There is extra PPE's, incontinence and the toxins are locked and secured inaccessible to the clients. There is one washer and dryer located in the garage.


Administrative: There is no annual fee that is due right now. The Insurance plan is updated. At the entrance of the facility there is COVID signs against the wall.

An exit interview was conducted, no citations were issued, and a copy of this report was given to the administrator.



SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024
LIC809 (FAS) - (06/04)
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