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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608838
Report Date: 08/28/2024
Date Signed: 08/30/2024 08:48:04 PM


Document Has Been Signed on 08/30/2024 08:48 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:VILLAGE AT NORTHRIDGE, THEFACILITY NUMBER:
197608838
ADMINISTRATOR:THOMAS REKOWSKIFACILITY TYPE:
740
ADDRESS:9222 CORBIN AVETELEPHONE:
(818) 350-2951
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY:194CENSUS: 154DATE:
08/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:54 AM
MET WITH:Mary Okahata TIME COMPLETED:
05:00 PM
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 Licensing Program Analyst (LPA) Mariana Agban arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA was greeted by staff at the front desk. LPA later met with Director of Assisted Living Mary Rose Okahata and the purpose of the visit was explained. LPA conducted a physical tour at 12:05 PM. LPA observed the following:
Common Areas: These include the living rooms, dining areas, activity rooms, and other shared spaces. All common areas were observed to be cleaned and properly furnished. Facility maintains a comfortable temperature of 77.0 F.

Bathrooms :in the common area were observed to have trash cans with lids and infection control prevention signs posted.

Laundry Area: LPA toured laundry area. No deficiencies observed.

Medication Room: Facility has a designated medication room where medications are kept inaccessible to residents.

Fire Alarms: are located throughout the facility. LPA was informed that Reg 4 testing will be conduced on Sept 4, 2024. Fire extinguishers are also located through the facility with service date 07/16/2024. Carbon Monoxide: alarms are located throughout the facility and are operable.

Kitchen area was toured, and LPA observed there to be sufficient one-week non-perishable foods and two days perishable food for all residents.

Bedrooms: were randomly selected to tour and were observed to have appropriate furniture. Bathrooms were observed to have grab bars and non-skid mats.

Outside areas: LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with various shaded areas for residents. There is a pool with a fence located outside that is designated for the independent living community. The pool door automatically locks after each entry. (Continue 809 C)

SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana AgbanTELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2024
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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: VILLAGE AT NORTHRIDGE, THE
FACILITY NUMBER: 197608838
VISIT DATE: 08/28/2024
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Due to time constraints, LPA was unable to complete the annual inspection during today's visit. Administrator was informed that a follow up visit will be conducted. During today's the facility was in compliance with Title 22 regulations. No immediate health and safety risks were observed.

Exit interview conducted. Copy of report provided.

SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana AgbanTELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC809 (FAS) - (06/04)
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