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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610432
Report Date: 10/17/2023
Date Signed: 10/17/2023 02:25:43 PM

Document Has Been Signed on 10/17/2023 02:25 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:HOLLYWOOD ROYALE GARDEN ASSISTED LIVINGFACILITY NUMBER:
197610432
ADMINISTRATOR:JOGANI, PINKALFACILITY TYPE:
740
ADDRESS:6054 FRANKLIN AVE.TELEPHONE:
(323) 466-2411
CITY:LOS ANGELESSTATE: CAZIP CODE:
90028
CAPACITY: 120CENSUS: DATE:
10/17/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Pinkal Jogani, Joey Ramirez, Abigail GiganteTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Michael Cava, Huma Rahimi, Leslie Ngo-Castaneda, Gina Saucedo, Gary Tan conducted a pre-licensing Required visit and inspection of the facility. LPAs met with Applicant/Licensee Pinkal Jogani, Administrator Joey Marquez, and Administrative Assistant Abigail Gigante, and explained the reason for the visit.

At 10:00am, with the assistance of Licensee , LPAs took a tour of the physical plant. The facility is a two story building with the garage located in the ground floor. The first and second floors will cater the residents. Required postings were observed in the entry area. The smoke alarms are hardwired and interconnected with the carbon monoxide detectors that functions properly. There fire extinguishers are located throughout the facility on the first, second and garage floors. The charge date is 3/18/2023.

Kitchen: The kitchen appliances and fixtures were functional. LPAs found a sufficient amount of non-perishable food at the facility; properly stored. Perishable food items are not required at this time as there are no residents. Knives will be stored in a locked cabinet.

Bedrooms: There were sixty four (64) bedrooms designated for residents' use. There are twenty six (26) on the first floor and thirty eight (38) on the second floor. Model rooms were inspected to ensure there is a bed night stand, drawer, sufficient closet space and lightings.

Bathrooms: All sixty four (64) bedrooms has its own bathrooms. In addition there are four (4) common bathrooms, two on each floor.

Common Areas: The first floor has two (2) dinning rooms and a patio area. Second floor has two (2) activity rooms and one (1) living room. The common areas were properly furnished.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2023
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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: HOLLYWOOD ROYALE GARDEN ASSISTED LIVING
FACILITY NUMBER: 197610432
VISIT DATE: 10/17/2023
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Surrounding Grounds: Entry/exits were free of obstruction. The laundry area is located on the first floor by the kitchen and room number 125. Laundry room will be kept locked and inaccessible to residents.

OFFICE/STAFF WORKSTATION: There are two (2) offices at the first floor. One is located at the left of the main entrance and the main office is located inner lobby. Staff and residents files will be maintained main/administrator office.

Medications: Medication room is located on the first floor adjacent to room number 118, 119, and 120. The medication will be kept locked at all times.

In addition to the Pre-Licensing inspection, a Component III power point presentation was also held.


Prior to licensure, the licensee/applicant will need to submit the following proof repairs.
  • Floor for room 238, needs replacement. The licensee will submit photos to CCL once its replaced
  • Closets in random resident rooms were missing tracks. The licensee will submit proof via photos to CCL that these tracks are put in place and repaired.
  • Random residents bathrooms did not have running hot water. The Licensee will keep a log for next seven (7) days of running hot water and insure the temperature is measured between 105 and 120. Log will be submitted to the CCL as proof of correction.
  • The grab bars in the shower area in room number 116 requires tightening. Licensee will submit a photo as proof grab bars have been tightened.
  • Licensee/applicant needs to purchase an emergency evacuation chair for both stairwells in the building. As proof of purchase, licensee/applicant will submit photos and copy of receipt.

Applicant/licensee advised and a copy of this Report Issued.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
LIC809 (FAS) - (06/04)
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