195850496-8-14-2024-29-AS-VCOY-D85S7W-20240814133814

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 195850496
Report Date: 08/14/2024
Date Signed: 08/14/2024 01:38:23 PM

Document Has Been Signed on 08/14/2024 01:38 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	OHANA RECOVERY CENTER		FACILITY NUMBER:	195850496
ADMINISTRATOR/ DIRECTOR:	DRAKE, MELINDA		FACILITY TYPE:	772
ADDRESS:	1952 HAZEL NUT COURT		TELEPHONE:	(818) 571-9841
CITY:	AGOURA HILLS	STATE: CA	ZIP CODE:	91301
CAPACITY: 6		CENSUS: 0	DATE:	08/14/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:57 AM
MET WITH:	Melinda Drake		TIME VISIT/ INSPECTION COMPLETED:	02:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Valeria Conway conducted an announced pre-licensing visit to the above noted facility. The LPA met with Administrator, Melinda Drake and Program Director Mary Lou Perelmutter. This is a new facility. An application to operate a Social Rehabilitation Facility (SRF) was received by Community Care Licensing (CCL) on 01/19/2024. A Fire Clearance was approved for a maximum capacity of six (6) ambulatory clients on 07/26/2024. This will be an all-female facility. There are no staff rooms – ‘awake night staff only’. The proposed physical plant is a two (2) story single family dwelling located in a residential neighborhood of Agoura Hills, CA. At 9:05 A.M., A tour of the physical plant was conducted and the following observed: First Floor: The first floor consists in one (1) single master bedroom, an office, a group room, a juice/coffee bar, a dining room and a living room (common areas), a kitchen, a half (1/2) bathroom and a garage. Master bedroom was set up with a bed, night stand, lamp, chair and closet space. The bed was furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. The bedroom is large enough to allow for easy passage between the beds and furniture. The bathroom has a shower with non-skid materials. The toilet is functional at the time of the visit. At 9:11 A.M. hot water temperature measured at 112.3 degrees Fahrenheit. Continues on LIC 809-C

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024

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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: OHANA RECOVERY CENTER	FACILITY NUMBER: 195850496
	VISIT DATE: 08/14/2024

NARRATIVE

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Continued from LIC 809

The common areas including the juice/coffee bar, living room and the dining room were appropriately furnished, and the lighting was adequate. There are televisions and other entertainment equipment in the living room and dining area. Also, facility has an office space and a group room for relaxation and/or other group activities. There is a functioning telephone on the premises. The emergency exiting plans/sketch, emergency telephone numbers, and other required postings are posted in the common hallway.

Across from the juice/coffee bar and adjacent to the garage there is a half (1/2) bathroom, at 9:45 A.M. hot water temperature measured at 109.5 degrees Fahrenheit.

Kitchen knives will be stored in a locked drawer in the kitchen. The supply of dishes, utensils, pots, pans and drink ware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area. Appliances in the kitchen were clean and all appeared functional. Kitchen, laundry, and house cleaning supplies will be stored in a locked cabinet located in the kitchen and the garage. At 9:53 A.M. hot water temperature measured at 110.6 degrees Fahrenheit.

The LPA observed the garage door to be locked. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the garage. Medications will be centrally stored in a locked cabinet in the garage. Medicine cabinet and a two (2) medical refrigerator with locks were observed in the garage. The first aid kit will be locked inside the medication cabinet. Kit was complete, including a current version of a first aid manual. LPA observed sufficient emergency food at the time of the visit.

Continued on LIC 809-C

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024

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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: OHANA RECOVERY CENTER	FACILITY NUMBER: 195850496
	VISIT DATE: 08/14/2024

NARRATIVE

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Continued on LIC 809-C

There are various fireplaces at the home. They are all screened and there are no tools accessible. The facility has a furnace, which is able to heat rooms that clients occupy to a minimum of 68 degrees Fahrenheit; and, they have central air conditioning and are able to cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit. In addition, the physical plant is consistent with the submitted facility sketch. The facility has emergency lighting, which included flashlights, or other battery powered lighting, and batteries. Administrator will install night lights in the hallways for additional safety. The facility smoke alarm system is hard wired. The smoke detector and carbon monoxide detectors were tested and functioned properly during the time of visit. There are four (4) fire extinguishers throughout the house. They are fully charged and do not exceed the expiration date. The stairway leading to the second floor is equipped with sturdy, hand railings.

Second Floor:

The second floor consists in 4 bedrooms, 3 bathrooms, a laundry room and a sitting room.

Bedrooms 2-5 were set up with a bed, night stand, lamp, chair and closet space. The bed was furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. All bedrooms are large enough to allow for easy passage between the beds and furniture. Room #2 is a master bedroom for single occupancy. Room #3 and #4 will share the toilet and the shower, however, room #3 and #4 have their own vanity sink. Room #5 is a master shared room with a balcony. All bathrooms have a shower with non-skid materials and the toilets are functional at the time of the visit. Between 9:20-9:40 A.M. hot water temperatures were measured in all client bathrooms and measured within the required range of 105 degrees F to 120 degrees F at the time of the visit.

LPA observed a sitting area with a television and chairs for activities and relaxation. LPA observed two (2) closets with extra bed and bath linens supplies. All rooms were free of odors.

Continued on LIC 809-C

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024

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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: OHANA RECOVERY CENTER	FACILITY NUMBER: 195850496
	VISIT DATE: 08/14/2024

NARRATIVE

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Continued on LIC 809-C

Laundry room was observed unlocked. Laundry supplies and chemicals are locked and will be stored in the a cabinet inaccessible to residents in care. Facility staff will help clients to do their laundry when necessary.

Exterior:

The Front Yard includes a driveway, paved walkways, and landscaped areas. The backyard is fenced and includes both paved and landscaped areas, a covered patio, furniture appropriate for outdoor use. There is one (1) side gate door with self-latching mechanisms. During the visit, LPA, Administrator and Program Director observed gate was not self-latching and need it to be repaired. The exterior passageways were clean and clear of any obstructions. The garage is accessible from the backyard; the door was locked. There was sufficient space to accommodate outdoor activities. All window screens were clean and maintained in good repair.

COMPONENT III ORIENTATION: A Component III Orientation was conducted with Administrator Melinda Drake and Program Director Mary Lou Perelmutter during today's visit.

The following needs to be completed/Photos sent to LPAs prior to licensure:

· Fix gate to self-latch.

· Purchase night-lights.
· Order emergency water.

This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.

Exit interview conducted. A copy of the Licensing Report was issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024

LIC809 (FAS) - (06/04)

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