198603179-4-12-2022-28-AS-NMAN-CDEUZ5-20220412160057

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603179
Report Date: 04/12/2022
Date Signed: 04/12/2022 04:01:03 PM

Document Has Been Signed on 04/12/2022 04:01 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	DRYDEN GARDENS		FACILITY NUMBER:	198603179
ADMINISTRATOR:	MINSHULL, ARMEN		FACILITY TYPE:	740
ADDRESS:	610 W DRYDEN STREET		TELEPHONE:	(818) 919-4139
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91202
CAPACITY: 6		CENSUS: 2	DATE:	04/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Administrator Armen Minshull		TIME COMPLETED:	04:00 PM

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Licensing Program Analyst (LPA) Nune Margaryan conducted an annual required visit. LPA met with Administrator Armen Minshull who assisted with the visit. Reason for the visit was explained. LPA used the infection control tool to evaluate the facility. LPA inspected the physical plant, COVID-19 procedures, reviewed residents' medications, observed food supply, and reviewed residents and staff files. The facility is licensed for six (6) residents over the age of 60, with a hospice waiver for six (6) residents. There is currently no resident on hospice. Mitigation plan was submitted on 7/23/2021.

There is only one entrance being utilized at the facility, all required posters were posted at the entrance. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. LPA was screened upon entry. All staff were observed to be wearing mask upon entrance and during visit.

LPA inspected the interior and the exterior of the facility with Administrator including but not limited to living room, dining room, kitchen, three (3) resident bedrooms, two (2) bathrooms, laundry which is located in the back of the kitchen and backyard. LPAs observed that the facility does not have a swimming pool or other bodies of water. All indoor and outdoor passageways are free of obstruction.

Bathrooms and bedrooms were clean and in good repair. All residents bedrooms were toured. Each bedroom were furnished with required furniture and had sufficient closet space. Both bathrooms were toured. Bathrooms have the required grabs bars and non-skid mats. The hot water was 116.2 and 117.5 degrees which is within the required 105 - 120 degrees. LPA observed fire extinguisher near the kitchen which was fully charged. Carbon monoxide detectors were observed throughout the facility. First-aid Kit is complete and located in the kitchen. There is a locked cabinet for medications in the office area located in the dinning room.

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SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: DRYDEN GARDENS	FACILITY NUMBER: 198603179
	VISIT DATE: 04/12/2022

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The kitchen was toured. All appliances were operating properly. There was a sufficient amount of perishable and non-perishable food. Kitchen knives and sharps are stored in a locked drawer in the kitchen. The common areas including the living room and dining room are clean and have the required furniture. The backyard has a shaded area and sitting area. The facility has cameras in the common areas only.

LPA reviewed residents files to confirm emergency contact is updated. LPA also reviewed staff files to confirm health screenings and fingerprint clearances. All staff files reviewed were fingerprint cleared. Residents' medications were reviewed. Medications are documented properly and stored appropriately.

Based on California Code of Regulations, Title 22, there were no deficiencies observed during the visit.

A copy of the report was provided to the Administrator.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Nune Margaryan
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022

LIC809 (FAS) - (06/04)

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