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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610272
Report Date: 06/20/2022
Date Signed: 06/20/2022 11:53:15 AM

Document Has Been Signed on 06/20/2022 11:53 AM - 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:TOPANGA GARDENS RESIDENTIAL HOME CAREFACILITY NUMBER:
197610272
ADMINISTRATOR:ILLENBERGER, JEFFREY MICHAFACILITY TYPE:
740
ADDRESS:21709 RODAX STTELEPHONE:
(818) 325-6870
CITY:CANOGA PARKSTATE: CAZIP CODE:
91304
CAPACITY: 6CENSUS: 0DATE:
06/20/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jeffrey IllenbergerTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Wendell Smith conducted an announced Pre-Licensing Visit. LPA met with applicant and explained the reason for this visit.
Facility is cleared for five non-ambulatory residents and one bedridden resident in room #4. Facility has four bedrooms and two bathrooms for resident use. Bedrooms #1 and #4 are private rooms while bedrooms #2 and #3 are shared rooms. All bedrooms were observed to be properly furnished. LPA checked bathrooms and observed there to be skid mats. During the visit grab bars were installed next to the toilets.
LPA observed all common areas to be appropriately furnished. LPA observed the facility to have a sun room that is accessible to residents. It will be locked from the inside and residents will be able to access it from the outside by ramp. LPA checked the kitchen for the ability to prepare and store food. LPA observed knives and sharp objects to be locked away and inaccessible. LPA observed all the required postings to be posted in the hallways. Facility has carbon monoxide/smoke detector that was observed to be working properly. LPA observed fully charged fire extinguisher was in the dining room, hallway, and garage. The garage area is locked an inaccessible from residents. In the garage area is where the washer and dryer are located. LPA toured the backyard of the facility and observed it to be free of clutter and debris. There is a small office in the backyard which will be locked and inaccessible from residents. Front yard and backyard of the facility is fenced and alarmed. All exit doors were observed to be alarmed.
During the visit LPA also conducted a Component III with the applicant.
Exit Interview was conducted. LPA will follow up with the Central Application Unit.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2022
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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