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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191222593
Report Date: 06/10/2022
Date Signed: 06/10/2022 12:36:15 PM

Document Has Been Signed on 06/10/2022 12:36 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:COMMUNICATION IMPROVEMENT GUIDANCE CENTERFACILITY NUMBER:
191222593
ADMINISTRATOR:AGBEDE, SONNYFACILITY TYPE:
735
ADDRESS:15030 SEPTO STREETTELEPHONE:
(818) 891-6555
CITY:MISSION HILLSSTATE: CAZIP CODE:
91345
CAPACITY: 6CENSUS: 5DATE:
06/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ana Rojas, AdministratorTIME COMPLETED:
12:42 PM
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Licensing Program Analyst (LPA) Tihesha “Lynn” Smith conducted an unannounced annual/infection control visit to this facility at 9:00 am and observed COVID signs on the front door. LPA was greeted by caregiver Pierrot Ntoya and temperature taken upon entry. LPA was given sign in log to record temperature and answer Covid follow-up questions printed on sign in log sheet. The administrator was called and arrived at 9:30 am.

LPA conducted a tour of the physical plant at 10:25 am to ensure there are no health and safety hazards and facility staff are following Title 22 Regulations and the following was noted:
The facility had a Mitigation plan and copy received.

Hand washing, coughing etiquette, physical distancing, and other necessary signs were posted in the bathroom and all over the facility.

The facility has four (4) bedrooms: three (3) bedrooms for clients and one (1) bedroom designated as staff room/office. There is a half bathroom (toilet/sink) in bedroom #3 and (2) two bathrooms: one (1) near bedrooms #1 and # 2 and one (1) bathroom in staff room/office. There is no body water in the facility.

Bedrooms All bathrooms were clean, properly supplied and had functional fixtures. Linen storage was also checked and observed to have sufficient supply of clean linen.
Bathrooms were observed to be clean and sanitary with sufficient supplies. Hot water temperature range between 105 and 120-degrees Fahrenheit.
Physical plant was checked for cleanliness and condition. Facility was in good repair and observed to be clean on today’s visit.
Living and dining room combo was observed to be clean and furniture in good condition and adequate seating for clients. LPA observed an adequate supply of PPEs store in closet to left of front door and a small (Cont to 809C)
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE: DATE: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/10/2022
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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: COMMUNICATION IMPROVEMENT GUIDANCE CENTER
FACILITY NUMBER: 191222593
VISIT DATE: 06/10/2022
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(Cont from 809)

table to the right of front door holds masks, gloves, and hand sanitizer available including several hand sanitizing stations throughout facility.
Kitchen area was observed to be clean. Sharps, Hygiene back stock, cleaning supplies and other toxins are locked in upper cabinet across from refrigerator.
Food. The facility is observed to have sufficient food supply for the clients both perishable and non-perishable.
Medication are located in staff room/office and stored in locked metal file cabinet. There are two first aid kits located in staff room/office and stored in locked closet with facility files.
Fire extinguisher There is one (1) fire extinguisher in the facility located in the hallway near room #1 and #2. The extinguisher was observed to be charged. Dual Smoke alarms and carbon monoxide are hardwired and interconnected, were tested and observed to be functioning.
Laundry area is located off the kitchen on the outside (side area) of facility. Laundry machines observed to be in good repair at time of visit. The backyard has a gazebo with adequate seating for the clients.

Garage observed and used as food/emergency water storage and staff outdoor break area. LPA observed two (2) additional refrigerators: one (1) for staff use and one (1) used to store frozen foods for clients.

The grounds entry/exits area were clean with and free of obstruction.

There was no immediate health and safety hazard observed during the day of inspection. There are no deficiencies to report.

Exit interview conducted, appeals rights discussed, and a copy of this report was given.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022
LIC809 (FAS) - (06/04)
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