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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197600348
Report Date: 04/24/2024
Date Signed: 04/24/2024 04:29:00 PM

Document Has Been Signed on 04/24/2024 04:29 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:JARAVATA TRIBUNE HOMEFACILITY NUMBER:
197600348
ADMINISTRATOR/
DIRECTOR:		JARAVATA, MINAFACILITY TYPE:
735
ADDRESS:18416 TRIBUNETELEPHONE:
(818) 831-1332
CITY:NORTHRIDGESTATE: CAZIP CODE:
91326
CAPACITY: 4CENSUS: 4DATE:
04/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Maria Fe del RosarioTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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At 9:20 a.m. on 04/24/2024, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA was unable to gain entry to the facility, and no staff or clients were observed. LPA returned at approximately 2:00 p.m., met with the administrator, and disclosed the reason for the visit. LPA and administrator toured the facility inside and out.

The facility was last visited on 12/02/2023 for an annual inspection. It is a single story building with four (04) bedrooms, two (02) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for four (04) ambulatory residents.

LPA observed a maintained front yard, gardened areas, and a shaded bench swing at the front. A screening station contained hand sanitizer, a digital thermometer, and a visitor log. Postings included COVID precautions, facility sketch and license, confidential complaint contacts, emergency disaster plan, and resident schedules.

Walls, floors, windows, screens, and blinds were clean and in good repair. At 2:15 p.m. the room temperature was measured to be 73 degrees Fahrenheit. A fireplace in the living room was covered. Staff and client files were locked in an office area. Furniture was in good repair. A linen closet by the living room contained a adequate supply of fresh linens.

The facility has four (04) bedrooms. One (01) bedroom is designated as a staff room. The staff room was free of hazards. All bedrooms contained a chair, lamp, nightstand, storage, and a bed with adequate bedding. All furnishings were clean and in good condition.

The facility has two (02) bathrooms. All bathrooms contained liquid soap, paper towels, handwashing instruction sign, and a trash can with a tight fitting lid. At approximately 2:30 p.m. LPA measured the water temperature in the client bathroom to be 1006.4 degrees Fahrenheit.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: JARAVATA TRIBUNE HOME
FACILITY NUMBER: 197600348
VISIT DATE: 04/24/2024
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LPA observed a covered patio area in the rear of the facility. The patio contained furniture in good condition. Additional gardened areas were present in the back yard. Two (02) out of two (02) emergency exits were unlocked. Emergency exit paths were free from obstructions.

The garage was locked and contained emergency food and water supplies, additional PPE, and client belongings. A washing machine and dryer were also in the garage. Both were in working order. Detergents and sharps were locked in a nearby cabinet.

LPA observed an adequate supply of perishable and non-perishable foods in the kitchen. The stove hood was clean. Appliances were in good condition. A menu was posted on the refrigerator. Cleaning solutions were locked below the sink. Medications were locked by the dining area.

At approximately 2:45 p.m., smoke and carbon monoxide detectors were tested and operational. At approximately 2:55 p.m. LPA observed a fully charged fire extinguisher in the kitchen. It was last inspected on 02/21/2024.

At 3:10 p.m. LPA and administrator inspected the facility vehicle. Ignition, seatbelts, and windows were all operational.

LPA conducted a record review of client and personnel files at 3:30 p.m. All required documents were present.

During today's inspection, the facility was in compliance with Title 22 regulations. No immediate health and safety risks were observed.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024
LIC809 (FAS) - (06/04)
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