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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610099
Report Date: 01/31/2022
Date Signed: 01/31/2022 03:08:20 PM

Document Has Been Signed on 01/31/2022 03:08 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
CCLD Regional Office, 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: 50DATE:
01/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Nieva RuizTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced annual required visit.
LPA met with facility staff and explained the reason for this visit. Facility is fire cleared for forty-six non ambulatory residents, twelve non-ambulatory, and ten bedridden residents. All non-ambulatory residents are to be building 2. Building 2 is fully sprinklers related to smoke detector. All other buildings are ambulatory.
LPA conducted a physical plant tour to ensure compliance with Title 22 regulations. Facility has five different buildings which residents reside in. LPA toured each building and observed all buildings to be appropriately furnished. LPA checked random resident bedrooms and observed them to be furnished. LPA checked the common areas restrooms and bathrooms. LPA observed them to have grab bars and non skid material. Throughout the common areas of the facility LPA observed there to be posters reminding residents to keep six feet distance and follow covid-guidance with washing their hands. LPA observed stations with hand sanitizers throughout the buildings. LPA checked the facility kitchen for the ability to prepare and store food. LPA observed a sufficient amount of perishable and non perishable food. LPA observed smoke detectors and carbon monoxide detectors to be working properly. LPA observed the medication room to be locked and inaccessible from clients. No deficiencies cited during this visit. Exit Interview conducted.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2022
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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