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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197600299
Report Date: 04/01/2022
Date Signed: 04/01/2022 11:23:12 AM

Document Has Been Signed on 04/01/2022 11:23 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:RICHWAL CENTER II, THEFACILITY NUMBER:
197600299
ADMINISTRATOR:FLORENCE ORIMOLOYEFACILITY TYPE:
735
ADDRESS:8915 WOODLEY AVE.TELEPHONE:
(747) 529-6514
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 4CENSUS: 4DATE:
04/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Shirley Walker, LicenseeTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Shira Stamps met with Licensee Shirley Walker for an unannounced one (1) year Required visit for this facility. LPA arrived at 10:20 am and was greeted by caregiver Brenda Frazier. The Licensee arrived at 10:45am, and LPA informed the Licensee of the purpose of the visit.

Infection control: LPA reviewed the facility mitigation plan (approved on 03/07/21) to make sure the licensee was following current infection control recommendations. Upon arrival LPA was properly screened by caregiver Brenda Frazier.

A tour of the physical plant was conducted with the Licensee at 10:45 am. The facility has four (4) bedrooms and two (2) bathrooms currently occupying four (4) clients. Two (2) bedrooms are designated for staff use only.

Living and dining
At 10:45 am, LPA observed the two living room areas to be neat and clean along with the dining room. The facility maintains a comfortable temperature at 70°F. The smoke detectors and carbon monoxide detectors were tested and observed to be operational at 11:00 am. There is one (1) fire extinguisher located in the kitchen. The fire extinguisher was observed to be full and last serviced on 08/06/21. LPA observed the staff and client files locked in the filing cabinet.

Laundry
At 10:48 am, LPA observed the laundry room. LPA observed the medications and cleaning supplies locked in cabinets inaccessible to clients in care.

CONTINUED...
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE: DATE: 04/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/01/2022
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: RICHWAL CENTER II, THE
FACILITY NUMBER: 197600299
VISIT DATE: 04/01/2022
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Food Inspection
LPA conducted a tour of the kitchen around 10:49 am and observed a supply of seven day non-perishable and two day perishable foods. Food storage and preparation areas care clean and inaccessible to pests.

Resident Rooms
At 10:50 am, LPA observed rooms to have the appropriate bedding. There is a nightstand and sufficient lighting for each resident.

Physical environment/Garage
LPA toured the outside area of the facility at 10:52 am. LPA observed appropriate outdoor furniture. LPA observed a covered shaded area for clients. The facility has a gated pool that is not in use. LPA observed a detached garage used for storage. LPA observed a locked shed for extra supplies and storage.

Bathrooms
At 10:54 am LPA observed all bathrooms to have non-skid matts and the appropriated wash your hands signs posted in the bathroom. Hot water was tested and measured within regulation at 117.4 degrees F

Basement
At 10:55am LPA observed the basement used for extra PPE supplies and storage of the knives and sharp objects.

Administrative: Annual fee is current.

An exit interview was conducted, and a copy of this report was given to the Licensee.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:

DATE: 04/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2022
LIC809 (FAS) - (06/04)
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