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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610142
Report Date: 08/21/2024
Date Signed: 08/21/2024 04:34:29 PM


Document Has Been Signed on 08/21/2024 04:34 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:ATRIA TARZANAFACILITY NUMBER:
197610142
ADMINISTRATOR:IRMA ARTEAGAFACILITY TYPE:
740
ADDRESS:5325 ETIWANDA AVENUETELEPHONE:
(877) 483-6827
CITY:TARZANASTATE: CAZIP CODE:
91356
CAPACITY:136CENSUS: 108DATE:
08/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Irma ArteagaTIME COMPLETED:
04:35 PM
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At approximately 9:45 a.m. on 08/21/24, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with the administrator and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out.

The facility was last visited on 06/14/23 for a complaint visit. It is a four story building with 112 resident rooms, public and shared bathrooms, kitchen and dining areas, common areas, outdoor areas, business offices, activity rooms, gym, medication room, salon, and underground garage. It has an approved fire clearance for 136 residents, of which 25 may be non-ambulatory. Approved hospice waivers for ten (10).

At the main entrance, LPA observed postings for personal rights, rights of resident councils, confidential complaint contacts, facility license, facility sketch with evacuation routes, and ombudsman contacts. The front parking area was maintained and monitored by concierge. A doorbell is used for after-hours entry. The lobby contained furniture in good repair. Walls, floors, windows, screens, and blinds were clean and in good repair. At approximately 10:15 a.m. LPA measured the room temperature to be 74 degrees Fahrenheit. The southern hallway had business offices, the medication room, activity rooms, and the gym. The medication room was attended and inaccessible. Medications were locked and some were stored in the designated refrigerator. A complete first aid kit, two (02) medication carts, and emergency water supplies were also located in the med room. Activity rooms contained art supplies and reading materials. The gym was clean, and a resident was observed using the equipment. A jacuzzi outside was appropriately gated and locked. Patio furniture was shaded and in good condition. At approximately 10:30 a.m. LPA observed a fully charged fire extinguisher in the hallway. It was last inspected on 07/30/24. Daily activities and menus were posted in the elevators and throughout the hallways. The dining room was sanitary. The kitchen contained adequate supplies of perishable and non-perishable foods. The stove hood was clean. Appliances were in good condition. The kitchen was inaccessible. Cleaners were stored separate from the food storage areas. At approximately 10:45 a.m. the walk-in refrigerator and freezer temperatures were measured to be 38 and -2 degrees Fahrenheit, respectively. The laundry area was inaccessible and contained detergents, a washer, an iron press, and a dryer for large resident linens and facility linens. All appliances were in working order.

SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:
DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


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: ATRIA TARZANA
FACILITY NUMBER: 197610142
VISIT DATE: 08/21/2024
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The second, third, and fourth floors contained resident rooms. Resident rooms with oxygen in use contained appropriate signage outside. Each floor also had additional fire extinguishers in hallways and emergency exits which were free from hazards. Emergency evacuation chairs were observed in stairwells. Resident rooms contained kitchens, a washer and dryer, living rooms, bathrooms, and bedrooms. At approximately 11:00 a.m. LPA and the administrator tested the call system in Room #213. Staff arrived within seven (07) minutes. At 11:10 a.m. LPA measured the hot water in the resident bathroom to be 110.4 degrees Fahrenheit. At 11:15 a.m., the smoke and carbon monoxide detector was hard-wired and functioned when tested. At approximately 11:25 a.m. LPA and administrator tested the call system in room #403 and measured the hot water temperature in the bathroom to be 113.8 degrees Fahrenheit. Bedrooms contained a chair, lamp, nightstand, storage television, and a bed with adequate bedding. All furnishings were clean and in good condition. Private and shared bathrooms contained liquid soap, paper towels, trash cans with a tight fitting lids, grab bars near the toilet and shower, and a non-skid mat in the shower.

At 11:30 a.m. LPA conducted a medication review. All resident medications were present in correct quantities, and all medication records were signed completely. At 12:00 p.m., LPA conducted a records review of resident and personnel files as well as the most recent fire safety tests. On 09/09/23, all fire and emergency safety systems passed inspection. All confidential files were available and complete.

During today's inspection, 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: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas ReedTELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2