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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610099
Report Date: 01/27/2024
Date Signed: 01/27/2024 03:12:46 PM


Document Has Been Signed on 01/27/2024 03:12 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:WYNGATE VILLA GARDENSFACILITY NUMBER:
197610099
ADMINISTRATOR:ESPINAL, ALMAFACILITY TYPE:
740
ADDRESS:7634 WYNGATE STREETTELEPHONE:
(818) 352-4270
CITY:TUJUNGASTATE: CAZIP CODE:
91042
CAPACITY:68CENSUS: 45DATE:
01/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Oscar Chavez - AdministratorTIME COMPLETED:
03:09 PM
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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced Required One (1) year visit at this facility today. LPA initially met with staff Vanessa Rodriguez who called the administrator and explained the reason for the visit. The Administrator Oscar Chavez arrived fifteen (15) minutes later.

A tour of the physical plant was conducted at 9:25 AM and the following was noted:

The facility consists of five (5) buildings, each house has one main entrance. There are required posters posted at each main door and all over the facility. Screening area is located immediately upon entrance. Sign in sheet and hand sanitizer is available. All the staff were observed to be wearing mask. The facility had an approved Mitigation Plan.

Signs to wear a mask and other COVID-19 prevention protocol signs were posted outside the door. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has multiple screening stations all through out the facility. The facility has sufficient stock of PPE in the storage room.

The facility has five (5) buildings with a total of (34) shared bedrooms. Each building has their own bathrooms ranging from one at building #3 up to five (5) on building #2. The facility is fire cleared for forty six (46) ambulatory and twenty two (22) non-ambulatory residents, ten (10) of which maybe bedridden in building #2 only. Approved hospice for ten (10) residents. Common areas were inspected. All buildings has its own living room. Activity room is located on building #4 and dining area is located on building #2. Dining area was observed to be neat, clean and in proper order. The facility maintains a comfortable temperature at 74°F. There are carbon monoxide detector installed in the facility. Fire extinguishers are located all throughout the facility and last inspected on 04/07/23. The facility is equipped with emergency pull alarm and sprinkler system. (continued to LIC 809-C)
SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary TanTELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:
DATE: 01/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/27/2024
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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: WYNGATE VILLA GARDENS
FACILITY NUMBER: 197610099
VISIT DATE: 01/27/2024
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(continued from LIC 809)

Laundry room is located adjacent to the kitchen and was observed to be locked. Laundry detergents, cleaning agents and other toxins are stored in a locked cabinet in the laundry room inaccessible to the residents.

Food Service/Kitchen area was sufficiently stocked with two (2) days of perishable and seven (7) days of non-perishable food. Knives and sharp objects were observed to be locked and inaccessible to residents.

The residents' rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passage ways are lit.

The bathroom was checked for cleanliness and proper operation. LPA observed that there are appropriate grab bars in the showers and toilets. The hot water temperature at building # 1 measured at 106.6°F, building #2 at 112.6°F, building #3 at 119.2°F, building #4 at 116.9°F and building #5 at 115.8°F. There were enough clean linen available in the closets.

Medications were kept in a locked medication carts in the medication room. The medications were observed to be locked and inaccessible to residents. There are multiple complete first aid kits located in the medication room.

Facility emergency disaster plan was reviewed. Facility disaster drill was last conducted on 01/19/24. A fire inspection by the LAFD was last performed on 07/27/22 with validity until 03/31/24. There is no body of water in the facility. Back and front yard passageways were observed to be clear from obstruction. There is a shaded area on each building for the residents.

In addition to the physical plant inspection, residents and staff records were reviewed, LPA reviewed files of five (5) randomly selected residents. Residents files appear to be complete and updated. Six (6) staff files were also reviewed, staff files appear to be complete and updated.

Exit interview conducted. A copy of this report issued.
SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary TanTELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2024
LIC809 (FAS) - (06/04)
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