191221227-9-13-2023-31-AS-MAGN-CVMU4A-20230913151448

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191221227
Report Date: 09/13/2023
Date Signed: 09/13/2023 03:14:59 PM

Document Has Been Signed on 09/13/2023 03:14 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	BRIGHT EYES VII		FACILITY NUMBER:	191221227
ADMINISTRATOR:	FABREGAS, NORMA		FACILITY TYPE:	740
ADDRESS:	19601 ROSCOE BLVD.		TELEPHONE:	(818) 626-9494
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91324
CAPACITY:	6	CENSUS: 5	DATE:	09/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Norma Fabergas- Licensee		TIME COMPLETED:	03:30 PM

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On 09/13/23 Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. Upon arrival, LPA was greeted by staff and explained the reason for the visit. Shortly after, LPA met with Administrator Anna Fabergas and Licensee Norma Fabergas. A tour of the physical plant was conducted at 10:40AM.
Bedrooms: The facility has 7 bedrooms. Six (6) bedrooms designated for residents' use and (1) bedroom designated for staff. All bedrooms were clean, properly furnished and had sufficient lighting. Residents have enough personal hygiene products provided by the licensee. LPA observed enough and clean linen available in cabinets.

Common Areas: This includes the living room dining areas were appropriately furnished and lighting was adequate. The living room has a television and comfortable furniture.

Kitchen: The kitchen appeared clean and the appliances and fixtures functional. Sharp objects were stored in locked drawers and cabinets. Medications are locked in the kitchen cabinet. Medications observed to be locked and inaccessible to clients. LPA observed fully stocked first aid kit in the kitchen hanged against the wall next to the fire extinguisher. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored in the garage pantry. LPA observed fire extinguisher to be full and dated on 04-24-23.

Temperature: Facility maintains a comfortable temperature of 78 degrees Fahrenheit.

Bathrooms: There were three (3) bathrooms in the facility. One (1) bathroom in hallway which is the main and two (2) bathrooms in the private bedrooms. All bathrooms were clean, properly supplied and had functional fixtures. Water temperatures were: 112.2,114.3,115.5 degrees Fahrenheit. All chemical cleaners were locked under the sink cabinet.

Laundry Area: located through the kitchen. Appliances observed to be in good repair. All cabinets were locked and thus laundry detergents were inaccessible to residents. LPA observed fire extinguisher to be full and dated on 04-24-23. (Continue on 809 C)

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana Agban	TELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BRIGHT EYES VII	FACILITY NUMBER: 191221227
	VISIT DATE: 09/13/2023

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Garage: located through staff bedroom. LPA observed food pantry and many other storage boxes.

Surrounding Grounds: Entry/exits were observed to be locked. The outdoor area was clean and free of hazards. There is shaded area with table and chairs for residents use in the backyard. Patio furniture observed to be in good repair with adequate seating for the residents.

No deficiencies issued during today’s visit. Report was signed and delivered and an exit interview was conducted

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana Agban	TELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

LIC809 (FAS) - (06/04)

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