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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191222579
Report Date: 09/20/2023
Date Signed: 10/12/2023 08:33:07 AM

Document Has Been Signed on 10/12/2023 08:33 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:JARAVATA NORTHRIDGE HOMEFACILITY NUMBER:
191222579
ADMINISTRATOR:MARIA FE DEL ROSARIOFACILITY TYPE:
735
ADDRESS:9532 RHEA AVENUETELEPHONE:
(818) 882-9013
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 4CENSUS: 4DATE:
09/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:MARIA FE ROSARIO- AdministratorTIME COMPLETED:
02:00 PM
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On 09/20/2023 Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. Upon arrival, LPA was greeted by Administrator Maria Fe Rosario and House Manager Rachel Bangsail explained the reason for the visit. A tour of the physical plant was conducted at 10:15 AM.
Kitchen: The kitchen appeared clean and the appliances and fixtures functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. 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 cabinet.
Laundry Area: located through the kitchen. Appliances observed to be in good repair. Laundry detergents were locked and inaccessible to residents.
Temperature: Facility maintains a comfortable temperature of 78 degrees Fahrenheit.
Surrounding Grounds: Entry/exits were observed to be locked.LPA toured the outside area of the facility. LPA observed appropriate outdoor seating, with various covered shaded areas for clients. There are no bodies of water.
Smoke Alarms and Carbon Monoxide: The facility has 2 fire extinguishers located in the living room and kitchen, LPA observed to be fully charged and was purchased on 02/09/2023. Bathrooms: There were Three (3) bathrooms in the facility. Two (2) bathrooms in hallway which are the main and one (1) bathroom in the staff bedroom. All bathrooms were clean, properly supplied and had functional fixtures. Water temperatures were:114.5,115.7 degrees Fahrenheit. Bedrooms: The facility has 5 bedroom. Four (4) bedrooms designated for residents' use and one (1) bedroom is for staff. All bedrooms were clean, properly furnished and had sufficient lighting. 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. Garage: LPA observed the garage outside. LPA observed storage boxes and food supplies.
No deficiencies issued during today’s visit. Report was signed and delivered and an exit interview was conducted
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2023
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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