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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607629
Report Date: 12/16/2024
Date Signed: 12/16/2024 02:59:44 PM

Document Has Been Signed on 12/16/2024 02:59 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:RIDGEWOOD RESIDENTIAL CARE HOME #3FACILITY NUMBER:
197607629
ADMINISTRATOR/
DIRECTOR:		MARIA CRUZFACILITY TYPE:
740
ADDRESS:19231 DEARBORN STREETTELEPHONE:
(818) 626-9220
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 4CENSUS: 4DATE:
12/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Karla PlataTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analysts (LPAs) Mariana Agban and Nadia Shahbazian conducted an Annual Required visit and inspection of the facility. LPAs met with Assistant Administrator Karla Platta and explained the reason for the visit. At approximately 10:25 am, with the assistance of the Administrator, LPAs took a tour of the physical plant, and the following were observed:

Required postings were observed in the entry area. The smoke alarms are interconnected and battery-operated. There are carbon monoxide detectors that function properly in the residents' rooms. The fire alarms and Carbon monoxide detectors were tested at 10:40 AM. The fire extinguisher is located in the kitchen. The charge date is May 06, 2024. The facility has a working phone number and a landline.

Kitchen: The kitchen appliances and fixtures were functional. LPAs found a sufficient amount of properly stored perishable and non-perishable food at the facility. Knives were stored in a locked drawer in the kitchen.
Bedrooms: The facility has 6 bedrooms. There are four (4) bedrooms designated for residents' use. All four (4) bedrooms are designated for private use. There are two(2) bedrooms designated for staff use. All the bedrooms used by residents were properly furnished with appropriate bedding and linens with sufficient lighting.Bathrooms: The facility has three (3) bathrooms. There are two (2) bathrooms designated for residents' use. One (1) bathroom is designated for staff. Both bathrooms in use by residents were properly supplied and had functional fixtures. Hot water temperature was measured from the bathroom sink at 109.8 and 110.2 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. LPA observed in bathroom#1 extra incontinence and wipes supplies in the bathroom cabinet. Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. The dining room table is large enough to sit the capacity of the facility. Seating such as couches were in good repair and sat the capacity of the facility. Properly labeled medications were locked in one of the hallway cabinets.
(Continue on 809C)
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: RIDGEWOOD RESIDENTIAL CARE HOME #3
FACILITY NUMBER: 197607629
VISIT DATE: 12/16/2024
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Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor
use. The outdoor area was free of hazards. There is a swimming pool that is fenced all around its parameters. The fence was at least five feet high with a gate, that is also five feet high. The gate was observed locked, making it inaccessible for residents to enter.

Garage/ Laundry Area: The garage is attached to the house and can be entered from the second hallway next to the third (3) bathroom. There is a supply of extra paper towels, water supplies, PPEs, wheelchairs, incontinence, and wipes. There is an additional refrigerator with extra food. The laundry area is located in the garage with a washer and dryer. No laundry detergents or toxins were present in the laundry area during the inspection.

Resident Files: LPAs conducted a file review of resident records to ensure compliance with licensing forms.

Cash Resources: LPAs with the assistance of the Assistant administrator reviewed cash resources for all four residents. Logs and cash resources were consistent.

Staff Files: LPAs also conducted a file review of staff records to ensure forms and training are up to date and in compliance with licensing forms.

Medications: Medication and Medication Records were reviewed for proper documentation.

Temperature: The facility maintains a comfortable temperature of 75 degrees Fahrenheit

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC809 (FAS) - (06/04)
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