197600711-6-12-2023-31-AS-TSMH-CSQV5G-20230612160756

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197600711
Report Date: 06/12/2023
Date Signed: 06/12/2023 04:08:00 PM

Document Has Been Signed on 06/12/2023 04:08 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:	RAINBOW HORIZONS II		FACILITY NUMBER:	197600711
ADMINISTRATOR:	TRACY KENNEDY		FACILITY TYPE:	735
ADDRESS:	15917 CHASE STREET		TELEPHONE:	(818) 894-9301
CITY:	NORTH HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY: 6		CENSUS: 6	DATE:	06/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Irene Boni		TIME COMPLETED:	04:15 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	At 9:15 am Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility. LPA was greeted by facility staff and disclosed the purpose of the visit.The administrator was present in the facility. LPA conducted a tour of the physical plant at approximately 9:30 am to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Common areas were observed for the ability to safely serve the needs residents. These included the living room, kitchen, and dining combination. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to be furnished appropriately with adequate seating for residents. LPA reviewed the food service areas, food storage and supply (perishable and nonperishable foods). The kitchen food supply was observed and sufficient for the six (6) residents currently residing there. Two (2) days of perishable food 7 days non-perishable food observed. The freezer is stocked with meats and frozen vegetables. There are two (2) additional stocked refrigerators in the garage. Canned goods and extra supply of food stored in pantry hall closet #1. Sharps/toxins stored and locked under kitchen sink; observed to be inaccessible to residents. Medication store in medication cart and observed to be inaccessible to residents. There are two (2) fire extinguishers: one (1) attached to wall in kitchen, and one (1) attached to wall in hallway near exit. Both fire extinguishers observed to be charged. Laundry room is in the garage. The appliances observed to be functional. Two fully stocked first aid kits stored in hallway closet#2.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023

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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: RAINBOW HORIZONS II	FACILITY NUMBER: 197600711
	VISIT DATE: 06/12/2023

NARRATIVE

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(Cont from 809)

The facility has a total of four (4) bedrooms and three (3) bathrooms. Three (3) shared rooms and two (2) bathrooms are for residents. One bedroom and bathroom for staff. The resident bedrooms were properly furnished with at least one chair, nightstand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPA observed a supply of linens in hall closet #3.

Each bathroom has posted “wash your hands” signs and the following items available: hand soap, paper
towels, and trash cans. The hot water temperature was measured for the two (2) residents’ bathrooms to ensure it is within the required range for residents’ comfort and safety. The water temperature range was between 124.1-130.1 degrees Fahrenheit with hot water caution signs posted.

Backyard has the following: Covered patio with two (2) tables and chairs. Patio furniture observed to be in good repair with sufficient seating for the residents.

Garage used to store food back stock, emergency water, PPEs, and supplies.

Smoke detectors/carbon monoxide detector (interconnected) were tested and operable at time of visit.

Facility grounds were free of hazards.

At approximately 12:50 pm, LPA reviewed files for the six (6) residing residents and three (3) staff. Resident files included but not limited to physicians’ assessment, IPPs, daily notes, and immunization records. Staff files reviewed for three (3) staff. Staff files had DSP training's and current First aid/AED/CPR certificates.

There were no immediate health and safety hazard observed during the day of inspection.

Exit Interview Conducted / A Copy of the Report Issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023

LIC809 (FAS) - (06/04)

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