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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191222593
Report Date: 06/18/2023
Date Signed: 06/18/2023 12:13:27 PM

Document Has Been Signed on 06/18/2023 12:13 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.ASC, 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: 3DATE:
06/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Sonny Agbede - AdministratorTIME COMPLETED:
12:10 PM
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An unannounced One (1) Year Required visit was conducted on this day by Licensing Program Analyst (LPA) Gary Tan. LPA met with Licensee Sonny Agbede and explained the purpose of the visit.

LPA conducted physical plant tour inside and out at 9:02 AM. During the tour, LPA observed that the facility has three (3) shared client bedrooms and two (2) bathrooms. Additional one (1) room is designated for the staff and additional one (1) bathroom is also designated for staff use. There is no body of water at the facility.

The front main door is the only entrance being utilized at the facility. There is a sign on the front door that everyone entering at the facility must wear mask. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. Hand washing, coughing etiquette, physical distancing, and other necessary signs were posted in the bathroom and all over the facility.

The facility had submitted and approved Mitigation and Infection Plan.

Bedrooms were toured and observed to be clean and furnished.
Bathrooms were observed to be clean, sanitary and with necessary supplies. Hot water temperature was measured at 115.6°F.
Physical plant was checked for cleanliness and condition. Facility was observed to be generally in good repair and clean during today's visit.
Living and dining room furniture were also checked for functionality (wear and tear). The furniture were observed to be in good condition.

(continued on LIC 809-C)
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2023
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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: COMMUNICATION IMPROVEMENT GUIDANCE CENTER
FACILITY NUMBER: 191222593
VISIT DATE: 06/18/2023
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(continued from 809)

Kitchen area was observed to be clean and sanitary. All disinfectants, cleaning solutions, poisons and sharps were locked in the cabinet located at the far end of the kitchen. Food. The facility is observed to have sufficient food supply for clients. Temperature of facility wall thermostat was set at 74.0°F and observed to be within the required range.

Fire extinguisher was located at the kitchen, it was last serviced on 05/19/23. Fire alarms were observed to be hardwired and interconnected. Carbon monoxide was observed to be installed and all alarms were tested and observed to be working.

Garage is attached to the house but has no access from the inside. Garage is currently being used as frozen food and old equipment storage. Cleaning solutions and laundry detergents are observed kept in the locked garage. Laundry area is located in the backyard.

Medication were observed to be locked, inaccessible and stored in the file cabinet in the staff room. Medication records and procedures reviewed with staff. First aid kits were observed to be complete with all the required items.

Client records were reviewed for current IPP (Individual Program Plan) and/or Needs and Service plans, physician report, admission agreements and P & I funds. Client records appeared to be complete and current. Staff records were also reviewed. Staff present have criminal record clearances and associated to this facility. Current training and first aid/CPR observed for staff on duty. Administrator's certificate observed to be current.

Disaster drill was last conducted on 02/01/23. Required posting observed in facility (complaint hot line poster).

There is no deficiency observed during today's inspection. Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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