197610432-11-8-2023-31-AS-MCAA-CXDUEZ-20231108143159

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610432
Report Date: 11/08/2023
Date Signed: 11/08/2023 02:32:39 PM

Document Has Been Signed on 11/08/2023 02:32 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 LIVING		FACILITY NUMBER:	197610432
ADMINISTRATOR:	JOGANI, PINKAL		FACILITY TYPE:	740
ADDRESS:	6054 FRANKLIN AVE.		TELEPHONE:	(323) 466-2411
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90028
CAPACITY: 120		CENSUS: 0	DATE:	11/08/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:09 AM
MET WITH:	Pinkal Jogani, Joey Ramirez, Abigail Gigante		TIME COMPLETED:	02:45 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) Michael Cava and Gary Tan conducted a second pre-licensing visit and inspection of the facility. LPAs met with Applicant/Licensee Pinkal Jogani, Administrator Joey Marquez, and Administrative Assistant Abigail Gigante. The purpose for this second pre-licensing visit is to make sure that corrections from the previous pre-licensing, dated on 10/17/23, have been made. At approximately 9:15am, 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 and throughout the facility. The smoke alarms and carbon monoxide detectors are dual and are hardwired. There are fully charged fire extinguishers 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 are 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. All the rooms on both floors were inspected by both LPAs. Model rooms were inspected to ensure there is a bed, night stand, drawer, sufficient closet space and lightings. Signal systems were tested to insure it is functional. Once activated, the lights will blink at the main office, and office staff will notify caregivers, via intercom, to respond to the room that has activated their signal system. Floors in resident rooms were inspected to insure it is cleaned and maintained. Closets were checked to insure the doors are on the railing and slide properly.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: HOLLYWOOD ROYALE GARDEN ASSISTED LIVING	FACILITY NUMBER: 197610432
	VISIT DATE: 11/08/2023

NARRATIVE

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Bathrooms: All sixty four (64) bedrooms has its own bathrooms. In addition, there are four (4) common bathrooms. Two bathrooms on each floor located by the elevators. Bathrooms were checked for non-skid showers, floors and for grab bars properly installed. The hot water in random bathrooms checked on the first floor measured between 110-114 degrees, and 113.7 to 117.8 degrees in random bathrooms on the second floor. There is also one common shower room, for residents that require a wheelchair, that can get rolled in. It is located on the first floor, next to the medication room.

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, cleaned, maintained and in good repair.

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. The facility has two stairwells. One stairwell is located on the west side of the building, near the kitchen. The other stairwell is located near unit number 111. There are two evacuation chairs stationed at each stairwells at the second floor.

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 in the administrator's office, located behind the main office at the inner lobby.

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.

Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment is observed to be compliant and ready for licensure. CAB will be advised and a copy of this report provided.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC809 (FAS) - (06/04)

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