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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197601724
Report Date: 05/16/2023
Date Signed: 05/16/2023 01:49:57 PM


Document Has Been Signed on 05/16/2023 01:49 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: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:
05/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Clyde AcabalTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the assistant administrator, Clyde Acabal and explained the reason for the visit.

At 10:45am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are battery operated and interconnected. The carbon monoxide detector is located in between rooms #5 and #6. It functions properly. The fire extinguisher is fully charged and located near the kitchen.

Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives and cleaning supplies were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets.

Bedrooms: The facility has six (6) bedrooms. There are two (2) private rooms and two (2) shared rooms. The other two (2) bedrooms are designated for the staff. The bedrooms designated for resident use were observed to be properly furnished with appropriate beddings and linens with sufficient lighting.

Bathrooms: There are four (4) bathrooms designated for residents' use. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 106 degrees Fahrenheit. No cleaning supplies were observed.

Common Areas: These included the living room and dining area. The common areas were properly furnished. Floors were cleaned and maintained. Passageways were clear of obstruction. Staff workstation maintains resident and staff records.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2023
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: RINALDI GUEST HOME
FACILITY NUMBER: 197601724
VISIT DATE: 05/16/2023
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Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor
use. Ramps and rails were checked to be installed firm and in place. The garage was used as storage space for extra beds and PPE supplies. There was also an additional storage for incontinent products. Both garage and storage space were observed to be locked. The outdoor area was free of hazards. The laundry area and detergents are located by the kitchen. No cleaning supplies and detergents observed accessible to the residents in care.

Resident Files: Resident files were kept and maintained at staff work station. LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. Staff files were also maintained at the staff work station.

Medications: Medication and Medication Records were review for proper documentation.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2