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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191221403
Report Date: 01/13/2025
Date Signed: 01/14/2025 07:57:01 AM

Document Has Been Signed on 01/14/2025 07:57 AM - 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:PORTER RANCH HOMES #1FACILITY NUMBER:
191221403
ADMINISTRATOR/
DIRECTOR:
PARICA, EMMAFACILITY TYPE:
740
ADDRESS:8301 CAPPS AVENUETELEPHONE:
(818) 993-5175
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
01/13/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Chita Beltara- AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with Administrator Chita Beltara and explained the reason for the visit. At approximately 10:10am, with the assistance of Administrator, LPA took a tour of the physical plant and observed the following: 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. The fire extinguisher is located by the kitchen area and was purchased on 07/16/2024. Smoke detectors/carbon monoxide. Dual smoke and carbon monoxide detectors were located throughout the facility, and they were tested and observed to be operational Bedrooms: There were four (4) bedrooms in the facility. Three (3) designated for residents' use. All three (3) bedrooms are designated for shared use. One (1) room is designated for staff use. All bedrooms, in use by residents, were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are two (2) bathrooms designated for residents' use. Both bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured from the bathroom sink at 109.4 and 110.3 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Common Areas: These included the living room and dining area. The common areas were properly furnished. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. Laundry Room: The laundry room was locked and inaccessible to residents. Temperature: Facility maintains a comfortable temperature of 74 degrees Fahrenheit Resident Files: LPA conducted a file review of resident records to ensure compliance with licensing forms. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and in compliance with licensing forms. Medications: Medication and Medication Records were reviewed for proper documentation.
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.
Eva MillerTELEPHONE: (818) 596-4373
Mariana AgbanTELEPHONE: 818-738-4525
DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2025
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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