197609342-12-28-2023-31-AS-RVAA-CYY3JX-20231228171815

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609342
Report Date: 12/28/2023
Date Signed: 12/28/2023 05:22:12 PM

Document Has Been Signed on 12/28/2023 05:22 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:	LOS FELIZ GARDENS		FACILITY NUMBER:	197609342
ADMINISTRATOR:	SHAPIRO, NONNA		FACILITY TYPE:	740
ADDRESS:	205 E LOS FELIZ ROAD		TELEPHONE:	(818) 241-2273
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	199	CENSUS: 113	DATE:	12/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:08 AM
MET WITH:	Nonna Shapiro, Administrator		TIME COMPLETED:	05:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced Required-1 year visit to this facility. LPA met with Administrator Nonna Shapiro and explained the purpose of today's visit. This is an RCFE with a capacity of 199. The census is currently 113. This is a 3 story building which consists of 100 resident bedrooms, large living room, large dinning room, activity room, t.v. room, wellness center, office and conference room. The facility consists of a three (3) level floor building with a total of 100 resident bedrooms (50 on the second level and 50 on the third level), each having its own bathroom. The first floor consists of the following: a lobby area, administrative offices, function room, dining area, activities room, T.V. room, laundry room, staff lounge, family visiting room, guest restrooms, storage rooms, kitchen, and a sitting garden. The facility also counts with two operable elevators. The facility fire clearance is maintained in conformity with State Fire Marshall regulations. The facility operates and is within capacity limits. Carbon monoxide and smoke detectors were tested and all were operable. No bodies of water were observed in or around the facility. The facility maintains a comfortable temperature. Hot water temperature was measured in the kitchen and in resident bathrooms and was within the required 105 degrees F and 120 degrees F. LPA observed the resident rooms to be properly furnished. Centrally stored medicines are kept in the medication room and are locked. There is a functioning call system in each residents' room. Outdoor and indoor passageways were observed to be free and clear of obstructions.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023

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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LOS FELIZ GARDENS	FACILITY NUMBER: 197609342
	VISIT DATE: 12/28/2023

NARRATIVE

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Pesticides/poisons are not stored in food areas, kitchen, or where kitchen equipment/utensils are stored. LPA observed there to be a minimum of one (1) week of nonperishable foods and two (2) days of perishable for the number of residents being served. Total daily diet has quality and quantity to meet resident's needs.

Grab bars were available for each toilet, bathtub and shower used by residents. Bathtubs/showers have nonskid mats or strips and surfaces. Licensee provides hygiene supplies such as soap and toilet paper.

There is one complete first aid kit.

Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023

LIC809 (FAS) - (06/04)

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