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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197601547
Report Date: 12/28/2022
Date Signed: 12/28/2022 01:09:20 PM


Document Has Been Signed on 12/28/2022 01:09 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:LARAMIE MANOR DBA JMPA RESIDENTIAL CAREFACILITY NUMBER:
197601547
ADMINISTRATOR:DINA PAMATMATFACILITY TYPE:
740
ADDRESS:10151 LARAMIE AVENUETELEPHONE:
(818) 998-4940
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY:6CENSUS: 5DATE:
12/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Pedro Endozo TIME COMPLETED:
01:15 PM
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On 12/28/22 Licensing Program Analyst (LPA) Joscelyn Martinez conducted an unannounced annual inspection. Upon arrival LPA met with staff and the purpose of the visit was explained. LPA contacted administrator and explained the purpose of today's visit.
A physical plant tour was conducted at 12:25 p.m and the following was observed:

Infection Control: Covid-19 infection signage was observed inside in the common areas. Staff screened LPA for covid symptoms and took LPA’s temperature. Facility has sufficient PPE supplies for more than 30 days. Food Inspection/Kitchen: LPA observed there to be sufficient stock of one-week non-perishable foods and two-day perishable foods. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers in the kitchen. Sharps are centrally stored in a locked area. Medication are centrally stored in a locked cabinet. Chemicals are stored under the kitchen sink and are locked. Smoke detectors/carbon monoxide are located throughout the facility and are dual hardwired. Smoke detectors and carbon monoxide detectors were tested at approximately 12:40 p.m. and appear to be functional. Fire extinguisher was observed to be charged with a service date of 02/16/22. Common Areas: All common areas were observed to be clean and properly furnished.. Laundry area is located near the kitchen area and. Resident Rooms: Facility has six (6) bedrooms of which one is designated for staff use. All six (6) bedrooms were toured and appear to be clean and properly furnished. LPA observed additional bedding and linens sufficient for all of the residents. All rooms have adequate lighting and furniture. Bathrooms: There are three (3) bathrooms in the facility. LPA observed all bathrooms to be cleaned. The hot water was tested and measured 120 F, which is in regulation. Grab bars and non-skid were observed. Garage: There is a garage attached the house that is accessible from the outside of the house. Garage is used for additional storage. Outside: LPA toured the outside area and observed appropriate outdoor furniture with a shaded covered area for residents. Facility has no bodies of water.

No deficiencies cited at this time. Exit interview conducted. Report signed and delivered

SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Joscelyn MartinezTELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:
DATE: 12/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/28/2022
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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