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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191220547
Report Date: 12/07/2023
Date Signed: 12/07/2023 01:05:52 PM

Document Has Been Signed on 12/07/2023 01:05 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:ROBINSON'S MANORFACILITY NUMBER:
191220547
ADMINISTRATOR:ROBINSON, REGINALDFACILITY TYPE:
735
ADDRESS:51 WEST ALTADENA DRIVETELEPHONE:
(626) 798-1666
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY: 6CENSUS: 0DATE:
12/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Laura RobinsonTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Tuesday Cabiness arrived to the facility to conduct Annual/Required inspection. LPA met with Administrator Laura Robinson who was informed the reason of the visit. The total capacity is (6), and the current census is (4). The facility has (4) bedrooms, with (1) room used for staff, and (2) bathrooms. Facility license, emergency disaster plan, rights of individuals with developmentally disabilities, and daily menu, and COVID signs visibly posted throughout the facility.

The physical plant tour of the inside and outside consisted of: Inside temperature was comfortable and cool. Common areas: living, dining, and kitchen were clean and properly furnished. Locked cabinets with knives, cleaning supplies, and toxic substances were locked and secured, underneath the kitchen sink, and garage area. Kitchen: The food service area had Licensing requirement of (7) day nonperishable, and (2) day perishable. LPA observed kitchen cabinets, stocked with canned goods. Snacks included chips, and fresh fruit are available. Refrigerator was clean, and stocked with frozen meat. Food was properly stored and wrapped in a healthy manner. Facility has extra freezer located in the garage, with frozen meat and vegetables. Bedrooms: Client rooms were appropriately furnished, with bedding and linens in good repair. Personal hygiene products are available for clients, are locked and stored in a cabinet. Bathrooms: were clean, with functional fixtures. There are grab bars and non-skid mats. Water temperature measured at 114.8 degrees Fahrenheit. Fire extinguisher fully charged. First aid kit was fully equipped. Smoke alarms, and carbon monoxide detectors were checked, and functioning properly. Surrounding grounds: Exit gate was open and easily accessible. Outside area had clear passageways, with no visible hazards. Furniture available outside for client's comfort and use. Earthquake and fire drill conducted monthly. Medication storage locked and secured. Centrally stored records and staff and client files reviewed; all required documents observed. All clients and staff are vaccinated and facility continues to COVID test weekly.

No citations issued, exit interview conducted, and copy of report provided.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2023
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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