<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610482
Report Date: 04/22/2024
Date Signed: 04/22/2024 10:59:36 AM

Document Has Been Signed on 04/22/2024 10:59 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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:ARDENT CHATEAUFACILITY NUMBER:
197610482
ADMINISTRATOR/
DIRECTOR:
DE GUZMAN, ROILANN CYELLFACILITY TYPE:
740
ADDRESS:27419 CHERRY CREEK DRIVETELEPHONE:
(661) 313-2988
CITY:SANTA CLARITASTATE: CAZIP CODE:
91354
CAPACITY: 6CENSUS: 0DATE:
04/22/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Roilann De GuzmanTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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 Analyst (LPA) Tuesday Cabiness conducted a PRE-LICENSING visit to the above address 27419 Cherry Creek Drive, Santa Clarita, CA 91354. LPA met with Administrator Roilann De Guzman. The inspection included, fire safety, personal accommodations, building and grounds, furniture/equipment, food service, and medication procedures. Fire Inspection was approved on March 20, 2024 which met fire department requirements for (6) private rooms, with room numbers 1, 5, and 6 to be used for non-ambulatory residents; and room numbers 2, 3, and 4, to be used for bedridden residents. Facility is pending approval for a hospice waiver for (6); and dementia waiver. Facility sketch, emergency disaster plan, complaint procedures, personal rights, emergency exit plan, and other required Licensing posters were visibly observed. COVID signs, visitor book, and hand washing station observed at the front entrance.

The physical plant was toured inside and out with Administrator. The facility is a one level home, with (6) private bedrooms with (2) bathrooms. The garage was converted into an ADU, and only to be used for caregivers and not residents. Food supply was inspected and observed, and storage areas, cabinets, pantries, cupboards counters, and refrigerator were clean and appropriate for food preparation. Knives and medication were stored in cabinets located in the kitchen area. Appliances were clean and functional, and utensils, plates, and cups were in good repair. Cleaning supplies, poisons, toxins and chemicals were locked and stored under the kitchen sink. There was enough supply of linens and towels, which were stored in a cabinet located in the hallway. Hygiene products were also available, which were locked and secured.

The common areas included the dining, living, bathroom, bedrooms, and ADU/staff office. Doors and passageways were clear and unobstructed. Walls, ceilings, floors, window screens and all other rooms were clean, in good repair, and appropriately furnished. Resident rooms observed to have a mattress with pad, sheets, pillow, bedspread, dresser, closet space, and chair. Bathrooms were clean had functional fixtures, with soap and towels, non-skid mats, grab bars and hand washing signs were posted. The water temperature measured at 119.0 degrees Fahrenheit.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2024
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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ARDENT CHATEAU
FACILITY NUMBER: 197610482
VISIT DATE: 04/22/2024
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
The back yard is completely fenced with a gate easily accessible and unlocked. There is a swimming pool that was gated and secured. There were no other visible hazards around the surrounding grounds. Patio furniture with covering available for resident's use.

Smoke detectors and carbon monoxide were hardwired and operating correctly. Fire extinguisher is fully charged. Telephone installation was completed. First aid kit inspected. Staff and client files will be stored a locked cabinet, located in the dining room area.

COMP III was completed during the visit.

Exit interview conducted and copy of report provided to Administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2