197610174-8-20-2024-31-AS-AAEA-D8BULW-20240820154126

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610174
Report Date: 08/20/2024
Date Signed: 08/20/2024 03:43:02 PM

Document Has Been Signed on 08/20/2024 03:43 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:	RIDGEVIEW HOME CARE CENTER		FACILITY NUMBER:	197610174
ADMINISTRATOR:	MANICDAO, MARY PRINCESS F.		FACILITY TYPE:	740
ADDRESS:	2327 RIDGEVIEW AVE		TELEPHONE:	(323) 308-8002
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90041
CAPACITY:	6	CENSUS: 5	DATE:	08/20/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Administrator Mary Manicdao		TIME COMPLETED:	04:00 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) Antonia Alvizar-Ettima conducted an unannounced Required (1) year inspection at this facility. LPA met with Administrator Mary Manicdao and explained the reason for the visit. A tour of the physical plant was conducted at 10:20a.m. and the following were noted: The main door is the only entrance being utilized for entry. Upon entrance there is an office and sign- in area. There are hand sanitizer all over the facility. Signs to wear a mask and other Covid 19 prevention protocol signs were posted on the walls. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. All trash cans were observed to have cover lids. The facility had submitted and approved Mitigation plan. The facility has six (6) bedrooms and four (4) bathrooms currently occupying five (5) residents in private rooms. The facility is fire cleared for six (6) bedridden residents and approved hospice waiver for two (2) residents. All smoke alarms were tested and function properly. The fire extinguisher was last serviced on 08/20/2024. Dual smoke and carbon monoxide are hardwired and inter connected and was tested and functions properly. Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with the family room. The facility maintains a comfortable temperature at 78°F. Cont. on LIC 809-C

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

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

FACILITY NAME: RIDGEVIEW HOME CARE CENTER	FACILITY NUMBER: 197610174
	VISIT DATE: 08/20/2024

NARRATIVE

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Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. The kitchen appeared clean and the appliances and fixtures functional. Cleaning supplies including detergents and other toxins are stored in the converted garage. Dishwashing liquid, knives and sharps are observed to be kept at the cabinet below the kitchen sink and was locked and inaccessible to residents.
Resident rooms are adequately furnished with appropriate furniture and lighting system. Residents have sufficient amounts of personal hygiene product which is provided by the licensee.
Bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The hot water temperature measured at a range of 110.4°F to 115.7°F. Towels and washcloths are not shared. There is enough clean linen available in stock in the linen cabinet.
Medications: LPA observed medication in the dining cabinet to be locked and inaccessible to residents. First aid kit is observed to be with complete tools and supplies.
Garage detached to the home and was converted to staff quarter, storage for frozen food and laundry area. Laundry detergents, cleaning agents and other toxins are stored and locked in garage inaccessible to the residents.
Backyard of the facility has outdoor furniture, with a covered shaded area for residents. The front and backyard passageways were clear of any obstruction. There is no body of water in the facility.
Staff records were reviewed. Staff present has criminal record clearances and associated to this facility.
Staff records appear to be complete and current. Resident records were also reviewed and appeared to be complete and current.

Disaster drill was last conducted on 04/05/24. Required posting are observed to be complete and current and displayed properly at the facility.

There is no health and safety issue observed during this visit. Exit interview conducted. A copy of this report issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

LIC809 (FAS) - (06/04)

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