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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197601724
Report Date: 05/24/2022
Date Signed: 05/24/2022 10:21:43 AM


Document Has Been Signed on 05/24/2022 10:21 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:RINALDI GUEST HOMEFACILITY NUMBER:
197601724
ADMINISTRATOR:MARILYN ACABALFACILITY TYPE:
740
ADDRESS:16016 RINALDI STREETTELEPHONE:
(818) 831-6602
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 6DATE:
05/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Clyde Acabal/ Assistant AdministratorTIME COMPLETED:
10:40 AM
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A Required One (1) year - Infection Control visit was conducted today by Licensing Program Analyst (LPA) Patrick Shanahan. LPA met with Assistant Administrator Clyde Acabal. Purpose of visit was stated. LPA observed that five (5) residents were at the facility during visit, the other one (1) is attending a day program. This facility is vendored by Regional Center as a level 4C.

A tour of the physical plant was conducted at 9:00 AM and the following were noted:

The main door is the only entrance being utilized for entry. There is a sign on the door that everyone entering at the facility must wear mask and must be screened. Screening area is located immediately upon entrance. LPA was screened by the staff upon entry. All staff were observed to be wearing mask.

LPA tested the smoke alarms and carbon monoxide detector and all functioned properly. The fire extinguisher was also functional.

No deficiencies observed during todays visit. Exit interview conducted and report issued.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick ShanahanTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2022
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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