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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197600711
Report Date: 04/16/2024
Date Signed: 04/16/2024 12:37:46 PM

Document Has Been Signed on 04/16/2024 12:37 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 IIFACILITY NUMBER:
197600711
ADMINISTRATOR/
DIRECTOR:		TRACY KENNEDYFACILITY TYPE:
735
ADDRESS:15917 CHASE STREETTELEPHONE:
(818) 894-9301
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 6CENSUS: 5DATE:
04/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:07 AM
MET WITH:Rosalie Alejandro, AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:42 PM
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At 10:07 am Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility. LPA was greeted by the administrator and informed all residents are at a day program. LPA conducted a tour of the physical plant at approximately 10:18 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 five (5) 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. Sharps/toxins stored and locked under kitchen sink; observed to be inaccessible to residents. Medication cart stored in medication in front office room and observed to be inaccessible to residents.

There are three (3) fire extinguishers: one (1) attached to wall in kitchen, one (1) attached to wall in hallway near exit and one (1) attached to patio wall. Fire extinguishers observed to be charged.

Laundry room is in the garage. The appliances observed to be functional. First aid kit attached to office wall and additional supplies in second hallway closet.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE: DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2024
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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: RAINBOW HORIZONS II
FACILITY NUMBER: 197600711
VISIT DATE: 04/16/2024
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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 across from Room #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 129.1-134.8 degrees Fahrenheit with hot water caution signs posted.

Backyard has the following: Covered patio with two (2) tables and twelve (12) 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.

LPA reviewed four (4) random resident files and two (2) random staff files at approximately 10:50 am. Resident files included but not limited to physicians’ assessment, admission agreements, and Individual Program Plan. Staff files reviewed for two (2) staff. Staff files current First aid/AED/CPR certificates and provider training.

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: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
LIC809 (FAS) - (06/04)
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