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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608844
Report Date: 01/28/2025
Date Signed: 01/29/2025 04:27:26 PM

Document Has Been Signed on 01/29/2025 04:27 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:TRIUMPHANT ELDERLY CARE LLCFACILITY NUMBER:
197608844
ADMINISTRATOR/
DIRECTOR:		RHODA K. GOCHINFACILITY TYPE:
740
ADDRESS:8106 LOMA VERDE AVENUETELEPHONE:
(818) 718-0978
CITY:CANOGA PARKSTATE: CAZIP CODE:
91304
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
01/28/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:RHODA K. GOCHIN- LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:10 PM
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Licensing Program Analysts (LPA) Leslie Ngo-Castaneda met with facility licensee Rhoda Gochin for a Plan Of Correction (POC) visit.

The purpose of the POC visit is to make sure deficiencies were corrected on reports issued on 12.16.2024.

Entrance interview conducted.

LPA toured the home and requested the following:

-CCR 87465(a)(6): Incidental Medical and Dental Care Services.

POC: Based on record review, the licensee did not comply with the section cited above in 6 out of 6 CSMDR which poses/posed a potential health, safety or personal rights risk to persons in care.

POC date 12.30.2024: POC Cleared during LPA visit.

-CCR 87465(h)(2): Incidental Medical and Dental Care Services.

POC: Based on record review, the licensee did not comply with the section cited above in 1 out of 1 S1, R4 and R6 medication was accessible which poses/posed a potential health, safety or personal rights risk to persons in care.

POC date 12.30.2024: POC Cleared during LPA visit.

Exit interview conducted. Copy of this report given.

Nichelle GillyardTELEPHONE: (818) 596-4370
Leslie Ngo-CastanedaTELEPHONE: (818) 214-9900
DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2025
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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