197610520-2-6-2025-31-AS-NSHN-DDN24W-20250206160438

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610520
Report Date: 02/06/2025
Date Signed: 02/06/2025 04:04:48 PM

Document Has Been Signed on 02/06/2025 04:04 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:	IVY PARK AT STUDIO CITY		FACILITY NUMBER:	197610520
ADMINISTRATOR/ DIRECTOR:	KASHANI, FARAZ		FACILITY TYPE:	740
ADDRESS:	4610 COLDWATER CANYON		TELEPHONE:	(818) 505-8484
CITY:	STUDIO CITY	STATE: CA	ZIP CODE:	91604
CAPACITY: 121	TOTAL ENROLLED CHILDREN: 0	CENSUS: 67	DATE:	02/06/2025
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Dan Kashani - Executive Director		TIME VISIT/ INSPECTION 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 Analysts (LPAs) Nadia Shahbazian and Gary Tan conducted a Pre-Licensing Inspection and met with the Executive Director Faraz (Dan) Kashani at 10:00 AM. LPAs explained the purpose of today’s visit. The facility is fire cleared for one hundred tweny one (121) non-ambulatory residents, eight (8) of whom may be bedridden. The facility is a four (4) story structure, consisting of the following: Ninety one (91) private resident bedrooms with own bathrooms, dining rooms, laundry rooms, activity rooms, offices, kitchen, outdoor patios, salon, and wellness and medication rooms. The third floor is reserved for memory care. At 11:15 LPAs inspected facility for Fire Safety, Personal Accommodations and Services, Food Service, and Medication Procedures. Hot Water temperatures were measured on randomly selected resident rooms on all floors and measured between 115.2 to 117.9 and LPAs ensured that grab bars were properly installed in every bathroom. Resident rooms were randomly inspected for health and safety. LPAs observed that a signal system is activated by a pull cord in each bathroom and bedroom. The signal system was tested from random resident rooms on several floors. Facility is also equipped with a signal system, activated when any exit door is opened. There are two exit doors on each floor with two (2) elevators. LPAs observed evacuation chairs by the stairwells. Continued on 809-C

Eva Miller	TELEPHONE: (818) 596-4373
Nadia Shahbazian	TELEPHONE: (818) 476-6033
	DATE: 02/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025

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

FACILITY NAME: IVY PARK AT STUDIO CITY	FACILITY NUMBER: 197610520
	VISIT DATE: 02/06/2025

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
26
27
28
29
30
31
32

There is no swimming pool or body of water on premises. Facility has a number of patio areas with adequate shading and a separate covered patio on the third floor for the memory care residents. LPAs visited the dining room and inspected the kitchen located on the first floor. The refrigerators, freezers and kitchen equipment were inspected to be in compliance with Title 22 regulations. LPAs observed that all sharp knives, cutlery and kitchen cleaners were kept locked in the kitchen. Chemicals and laundry detergents were also kept locked in laundry areas. Facility has adequate perishable and nonperishable food supplies. Storage rooms, garage and medication room were also inspected. First-aid kits are complete, medication cards were observed to be locked on several floors. LPAs ensured that the wellness center medical procedures were up to current and several resident medications were reviewed.

In addition to the Pre-Licensing inspection, Component III was conducted with the administrator.

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

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Nadia Shahbazian	TELEPHONE: (818) 476-6033
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025

LIC809 (FAS) - (06/04)

Page: 2 of 2