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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607629
Report Date: 12/22/2022
Date Signed: 12/22/2022 12:32:40 PM

Document Has Been Signed on 12/22/2022 12:32 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:RIDGEWOOD RESIDENTIAL CARE HOME #3FACILITY NUMBER:
197607629
ADMINISTRATOR:MARIA CRUZFACILITY TYPE:
740
ADDRESS:19231 DEARBORN STREETTELEPHONE:
(818) 626-9220
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 4CENSUS: 4DATE:
12/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Karla Plata TIME COMPLETED:
12:11 PM
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On 12/22/22 Licensing Program Analyst (LPA) Joscelyn Martinez arrived at the facility to conducted an unannounced annual inspection. Upon arrival LPA was greeted by staff and LPA’s temperature was taken. LPA Martinez later met with Designee Karla Plata. At 11:15 a.m. a physical tour of the facility was conducted and the following was observed:

Infection Control: Covid-19 infection control signage were observed outside of the facility. Proper signage was also observed inside in the common areas. Facility has sufficient PPE supplies for more than 30 days. Food Inspection: LPA observed there to be sufficient stock of one-week non-perishable foods and two-day perishable foods. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers in the kitchen. Sharps, cleaning supplies and medications are centrally stored in a locked area. Smoke detectors were tested at 11:33 a.m and were operational. Facility has carbon monoxide detectors in all of the clients rooms. Carbon monoxide detectors were tested and operational. Fire extinguisher has a service date of 06/15/2022. Common Areas: All common areas were observed to be clean and properly furnished. Facility maintains a comfortable temperature of 72.0 F. Clients Rooms: Facility has six (6) bedrooms which of four (4) are designated for client use. All six (6) bedrooms were toured and appear to be clean and properly furnished. Facility has three live in staff. LPA observed additional bedding and linens sufficient for all of the clients. Towels are not shared. All rooms have adequate lighting. Bathrooms: There are three (3) bathrooms in the facility of which two (2) are designated for client's use. LPA observed all bathrooms to have grab bars and non-skid mats. The hot water was tested and measured at 113.3 F. All trash cans located in the bathrooms had tight fitting lids. Garage: There is an attached garage that is being used for laundry area and additional storage. Outside Area: LPA observed appropriate outdoor furniture, with a covered shaded area for clients. There is a body of water that is gated. LPA observed gate to be locked and inaccessible to clients in care.

No deficiencies cited at this time. Exit interview conducted. Report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Joscelyn Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2022
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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