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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191221317
Report Date: 08/12/2024
Date Signed: 08/12/2024 02:14:42 PM

Document Has Been Signed on 08/12/2024 02:14 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:TOMANENG GUEST HOME IFACILITY NUMBER:
191221317
ADMINISTRATOR/
DIRECTOR:		ESTELA TOMANENGFACILITY TYPE:
735
ADDRESS:11204 GAVIOTA ST.TELEPHONE:
(818) 831-5767
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 6DATE:
08/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Joy Magdangal-Bonnet, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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On 08/12/2024 at 9:45 AM, Licensing Program Analyst (LPA) Gina Saucedo conducted an unannounced, Annual Inspection and met with Joy Magdangal-Bonnet, Administrator. LPA asked for the census, staff and client files.

The physical plant was toured inside and out at 10:50 am.

Living/Dining Room Area: LPA Saucedo observed the living room furniture to be clean and in good repair. The facility maintains a comfortable temperature at 76 degrees Fahrenheit with a large television.

Bedrooms: There are four (4) bedrooms. Three (3) are used for clients-shared and one (1) for a staff. In the hallway, there are four (4) closets one (1) with extra linen, two (2) for staff clothing and one (1) for medication, first aid and extra PPE's. LPA observed rooms to have bedding sheets, pillowcase, blankets, nightstands, televisions, and sufficient lighting for each of the Client’s room.

There is also a signal system in the facility. There is one (1) fire extinguisher fully charged and expires on July-2025 it is in the hallway of the bedrooms.

Bathrooms: There are two (2) bathrooms that were toured and checked to make sure bathrooms were clean and in good repair. The hot water temperatures were measured within regulations of 113 degrees. The showers have non-slip bathmats and grab bars.

Medications were kept in a locked closet at the entrance of the facility on your right-hand side. All medications were properly labeled and inaccessible to clients. The first aid kit is kept in this same closet.

Kitchen Area: LPA inspected the kitchen area. There is one (1) refrigerator which was clean and in good operation in this area and (1) freezer. LPA observed sufficient supply of seven (7) day non-perishable and perishable foods in the cabinets.

LIC809C-continued

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE: DATE: 08/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: TOMANENG GUEST HOME I
FACILITY NUMBER: 191221317
VISIT DATE: 08/12/2024
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The knives/sharps and chemicals are kept next to the kitchen area on your left-hand side, inaccessible to the clients. The washer and dryer are also kept in this area.

Outside: LPA toured the outside area. LPA observed a covered shaded area for clients and appropriate outdoor furniture. The facility has no body of water on the premises. There is one (1) gate that is unlocked leading to the outside area towards the street. There is one (1) shed that was opened and contains extra fire extinguishers, supplies and old equipment used as storage.

The carbon monoxide and the smoke detector were tested, and they were operable, interconnected.

There is no garage. There is an office located on your right-hand side of the facility by the kitchen. There is a telephone line located in this area.

Administration: The Liability Insurance was reviewed and will be renewed on 11/18/2024. There are several Covid 19 signs on the wall, hygiene sanitation signs, and the Rights of Individuals with Developmental Disabilities, YES, Emergency Disaster Plan and Facility Grievance Procedure. There is Personal and Incidental Funds kept at the facility which was checked and verified. This is a level three (3) Adult Residential Facility. The last Fire Drill was on July 13, 2024 and the last Earthquake Drill was July 14, 2024.

An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2024
LIC809 (FAS) - (06/04)
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