191221227-9-10-2024-31-AS-MAGN-D8YS8Y-20240910133955

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191221227
Report Date: 09/09/2024
Date Signed: 09/10/2024 01:42:18 PM

Document Has Been Signed on 09/10/2024 01:42 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: 6	DATE:	09/09/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Anna Faberigas		TIME COMPLETED:	02:00 PM

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) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with staff, and explained the reason for the visit. Administrator, Anna Fabergas had arrived shortly after. At approximately 10:05 Am with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are interconnected and battery-operated. There is a carbon monoxide detector functions properly. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets. LPA observed fully stocked first aid kit in the kitchen hanged against the wall next to the fire extinguisher. The fire extinguisher is fully charged with service date April 10, 2024. 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. The auditory alarms on all exit doors were on and functional at the time of the visit. 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. Bathrooms: There were two (2) bathrooms in the facility. One (1) bathroom in hallway which is the main and one (1) bathroom in bedroom#3. Both bathrooms were clean, properly supplied and had functional fixtures. Hot water temperature was measured from the bathroom sink at 113.8 degrees Fahrenheit. All chemical cleaners were locked under the sink cabinet. (continue 809C)

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana Agban	TELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024

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
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: 09/09/2024

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Temperature: Facility maintains a comfortable temperature of 78 degrees Fahrenheit
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 with service date April 10,2024.

Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

Medications: Medication and Medication Records were review for proper documentation.

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.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana Agban	TELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024

LIC809 (FAS) - (06/04)

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