197610191-7-10-2024-31-AS-GSAO-D72SZW-20240710141948

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610191
Report Date: 07/10/2024
Date Signed: 07/10/2024 02:20:16 PM

Document Has Been Signed on 07/10/2024 02:20 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:	GARDENS AT NORTHRIDGE, THE		FACILITY NUMBER:	197610191
ADMINISTRATOR/ DIRECTOR:	ANITA CSUKARDI		FACILITY TYPE:	741
ADDRESS:	17650 WEST DEVONSHIRE STREET		TELEPHONE:	(818) 886-1616
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY: 135		CENSUS: 91	DATE:	07/10/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:05 AM
MET WITH:	Lisa Villasenor		TIME VISIT/ INSPECTION COMPLETED:	02:45 PM

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On 07/10/24 at 9:05AM, Licensing Program Analyst (LPA) Gina Saucedo, arrived to conduct an unannounced, annual inspection at the facility. Upon arrival, LPA Saucedo met with Administrator, Lisa Villasenor and disclosed the purpose of the visit.

LPA asked for the census, resident, and staff files.

A physical tour was conducted at 11:30 AM and observed the following:

The entire facility has a total of 135 (one-hundred and thirty-five) beds. The facility is a two-story building: First floor and second floor: It is both assisted living and memory care. The facility has one (1) memory care units which is located at the back section of the facility and the assisted living is in the front section and upstairs. The memory care area can hold up to twenty-four (24) rooms and the Assisted Living area can hold up to 115 (one-hundred fifteen) rooms. The memory care door has a code and delayed egress on the doors. The Memory Care area of the facility has its own laundry room, living room area, dining hall area, enclosed patio area and a common shower that everyone uses. The assisted living side has their own activity room, salon, library, dining hall, two (2) patio areas with proper seating for residents and two (2) laundry areas one (1) upstairs and one (1) downstairs. There are chemicals that are inaccessible to the residents that are located in the laundry area with the washers and dryers. There are two (2) elevators throughout the facility.

Random Bedrooms were randomly selected to tour and were observed to have appropriate furniture, proper lights, bedding, and televisions.

LIC 809C-continued

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024

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

FACILITY NAME: GARDENS AT NORTHRIDGE, THE	FACILITY NUMBER: 197610191
	VISIT DATE: 07/10/2024

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Random Bathrooms were observed to have grab bars and non-skid mats. Hot water temperature was tested randomly for and measured 105–118-degree Fahrenheit.

There are two (2) medication rooms one (1) on the first floor and one (1) on the second floor. The medication is locked and inaccessible to the residents.

Fire extinguishers were observed throughout the facility and were fully charged on green with different dates. There are fire extinguishers upstairs, downstairs and in the kitchen area. Carbon Monoxide and fire alarms are located throughout the facility and are operable.

Common Areas: These include the dining areas, activities room, television rooms: All common areas were observed to be cleaned and properly furnished. Facility maintains a comfortable temperature of 72.-78-degree Fahrenheit. There are several temperature thermostats throughout the facility.

There are several common bathrooms throughout the upstairs and downstairs area. There are trash cans with lids and covid signs posted in the common bathrooms. There is toilet paper and napkins. The facility has no body of water.

The Kitchen area was toured, and LPA observed sufficient supply of non-perishable foods and perishable food for all residents. The kitchen area was clean at the time of the tour. The kitchen is located on the first floor. The assisted dining area has access to this kitchen where at the time of the tour different residents were having lunch with proper feeding utensils/plates/cups.

Administrative: There is no annual fee that is due right now. The Insurance plan is updated- 10/2024. There is an Emergency Disaster plan, House Rules, Rights of Resident Council, YES sign, Ombudsman and Theft and Loss Policy against the wall on your left-hand side of the facility near the entrance of the memory care.

An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024

LIC809 (FAS) - (06/04)

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