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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191222021
Report Date: 12/18/2023
Date Signed: 12/18/2023 01:10:39 PM

Document Has Been Signed on 12/18/2023 01:10 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:MAHARLIKA HOME IIFACILITY NUMBER:
191222021
ADMINISTRATOR:LEDESMA, NOELLIEFACILITY TYPE:
735
ADDRESS:17345 BURTON STREETTELEPHONE:
(818) 708-0627
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 6CENSUS: 5DATE:
12/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Noellie LedesmaTIME COMPLETED:
02:08 PM
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At 11:05 a.m., Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, annual visit. LPA was met by Noellie Ledesma, the licensee.

LPA asked for the census, client, and staff rosters. LPA observed covid infection control signs at the entrance of the facility, house rules, grievance, and monkey pox.

Temperature of facility wall thermostat is observed and set to 75 degrees Fahrenheit.

The physical tour started at 11:45 am. There is no garage only carport next to the house.

The laundry room has a washer and dryer and is located inside the staff office. The staff office has additional signs like the disaster plan, YES sign and Ombudsman. The staff office has an extra refrigerator and a freezer with extra food. There is one staff bedroom located inside the staff/office room.

Kitchen area was observed to be clean. The refrigerator is fully stacked and has the food menu. LPA reviewed the food service area, food storage and supply (perishable and nonperishable foods). The kitchen food supply was observed and sufficient for the five (5) clients currently residing there. There is an excess of perishables in several of the cabinets. The sharps and toxins are kept under the sink locked and inaccessible to the clients. There are two fire extinguishers throughout the house and smoke detectors. The fire extinguisher has a date of 03/2023 and fully charged. The smoke detectors were functioning properly.




LIC 809-C-continued
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2023
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: MAHARLIKA HOME II
FACILITY NUMBER: 191222021
VISIT DATE: 12/18/2023
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Medications are in a cabinet locked and secured in the staff office. The first aid kit and manual are also kept in a cabinet in the staff room. It is inaccessible to clients.

Backyard: There is a table set and chairs for clients use. There is enough seating for five (5) clients There is no pool.

Living and dining room furniture is accessible for five (5) clients. There is a television and enough seating for five clients. There is internet accessibility a phone line available for client use. Furniture was observed to be in good condition and the fireplace has a covering around it. There is a carbon monoxide against the wall. There is a large fish tank located in the living/dining room area.

There is another carbon monoxide detector in between two (2) client rooms against the wall.



Bedrooms: There is three (3) client bedrooms. Two (2) client’s bedrooms are shared. One of the shared rooms has a private bathroom. The other client bedroom is single, occupied. There is another bathroom located by the entrance of the house. The bathrooms read a temperature between 106.5 and 107.8 Fahrenheit. All bedrooms are properly furnished. The bathrooms have proper toiletry and grab bars. There is an extra closet in the hallway with extra linen.

Administrative: There is no annual fee due. The surety bond and the Insurance plan are updated.



An exit interview was conducted, no citations 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: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023
LIC809 (FAS) - (06/04)
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