197610403-9-13-2024-31-AS-RCOR-D93SRR-20240913140646

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610403
Report Date: 09/13/2024
Date Signed: 09/13/2024 02:06:51 PM

Document Has Been Signed on 09/13/2024 02:06 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:	GARDEN OF PALMS LA		FACILITY NUMBER:	197610403
ADMINISTRATOR:	HIRSCH,RENA		FACILITY TYPE:	740
ADDRESS:	1025 N FAIRFAX AVE		TELEPHONE:	(323) 656-7900
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	130	CENSUS: 106	DATE:	09/13/2024
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Adam Syncheff		TIME COMPLETED:	02:30 PM

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Licensing Program Analyst, (LPA) Raymond Comer, arrived to continue the required 1 Year Annual Inspection initiated on 09/12/2024. LPA met with Administrator, Adam Syncheff, and the purpose of visit was disclosed.

The following remaining domains were observed, reviewed and inspected:

Fire Detection/Protection system (continued) Fire extinguishers were observed throughout the facility on all floors, all extinguishers were last serviced on July 16, 2024. Evacuation chair was observed at the stairwell. Roof access is inaccessible to residents. Evacuation routes are clearly labelled and posted.

Laundry: At 12:35pm, LPA observed the laundry room located on sub-floor, adjacent to the kitchen. Laundry area is inaccessible to residents, and is clear from obstruction. Detergents, cleaning supplies, and other toxins are securely stored and inaccessible to residents.

Commons: Activity rooms, dining room, and library observed to be clean. Furnishings observed to be in good condition. No obstructions, nor tripping hazards observed.

Bedrooms: LPA observed accommodations in resident bedrooms and bathrooms for safety, privacy, and comfort. Eight (8) resident rooms (#105,#113,#121,#208,#201,#211,#231,#226) were inspected and observed to maintain required furnishings, sufficient lighting, bed linens, and blankets. All bedrooms were observed to be clean and clear from obstruction.

Bathrooms were observed to be clean and sanitary with necessary supplies and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured at 107.5°F. Within the required range.

[Continued on LIC 809-C]

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) -596-4373
LICENSING EVALUATOR NAME: Raymond Comer	TELEPHONE: 818-401-8655
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024

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: GARDEN OF PALMS LA	FACILITY NUMBER: 197610403
	VISIT DATE: 09/13/2024

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Outdoor: Courtyard area observed to have a shaded patio, with table with sufficient seating for the residents. Outdoor furniture observed to be in good condition. All trash cans were observed to be covered. There are no bodies of water in the facility.

Staff records: A total of eight (8) Staff files were reviewed. Criminal record clearances were present and Staff are associated to this facility. Staff records appear to be complete and current.

There were no immediate health and safety hazards observed at the time of this inspection. Exit interview conducted and a copy of this report was given to facility representative, Administrator Adam Syncheff.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) -596-4373
LICENSING EVALUATOR NAME: Raymond Comer	TELEPHONE: 818-401-8655
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024

LIC809 (FAS) - (06/04)

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