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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191220139
Report Date: 05/15/2024
Date Signed: 05/15/2024 05:54:10 PM

Document Has Been Signed on 05/15/2024 05:54 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:AIDAS BOARD & CARE HOMEFACILITY NUMBER:
191220139
ADMINISTRATOR/
DIRECTOR:		MALLA, FLORIDAFACILITY TYPE:
735
ADDRESS:45546 GADSDEN AVENUETELEPHONE:
(661) 406-4256
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 6CENSUS: 2DATE:
05/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:39 PM
MET WITH:Florida Malla - AdministratorTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
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Licensing Program Analyst (LPA) Gary Tan met with Administrator Florida Malla for a One (1) Year Required visit for this facility. LPA explained the reason for the visit.

A tour of the physical plant was conducted at 2:48 PM and the following was noted:

There is only one entrance being utilized at the facility, there are required poster posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Infection Control and Mitigation plan.

Signs to wear a mask and other Covid 19 prevention protocol signs were posted outside and inside. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room.

The facility has four (4) bedrooms and two (2) bathrooms currently occupying two (2) residents. One (1) bedroom and one (1) bathroom is designated for staff use. The facility is fire cleared for six (6) ambulatory residents.

Living and dining room furniture were also checked. The living room is neat and clean. The facility maintains a comfortable temperature at 75°F. The smoke detectors are battery operated and observed to be operational. There is a carbon monoxide installed at the facility. Fire extinguisher is located in the kitchen and last bought on 11/08/23. The backyard of the facility has shaded area with outdoor furniture, with a covered shaded area for clients. There is no body of water in the facility. (continued on LIC 809-C)
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2024
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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: AIDAS BOARD & CARE HOME
FACILITY NUMBER: 191220139
VISIT DATE: 05/15/2024
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(continued from LIC 9099)

There is no garage at the facility, only car ports at the front yard. The front yard is gated. Laundry room is located adjacent to the kitchen. Laundry detergents, cleaning agents and other toxins are stored in a locked in a cabinet in the laundry area. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. Cleaning solutions are kept locked in a cabinet under the sink.

The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lit. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. The bathroom was checked for cleanliness and proper operation. The hot water temperature was measured at 111.9°F. Towels and washcloths are not shared. There was enough clean linen available in stock at the cabinet. Staff room was observed to be locked during visit.



Medications: LPA observed medication in the bedroom hallway cabinet to be locked and inaccessible to residents. There is a complete first aid kit located in the kitchen.

Client records: Client records are reviewed. Client records appeared to be complete and updated.
Staff records: LPA conducted a complete file review of staff records. Staff records appeared to be complete and updated.

Disaster drill was last conducted on 04/29/24. Required posting observed in facility (complaint hot line poster).

Pursuant to Title 22, Division 6, Chapter 8; there was no deficiency observed during today’s inspection. Exit interview conducted and a copy of this report was given.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024
LIC809 (FAS) - (06/04)
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