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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197602074
Report Date: 10/12/2023
Date Signed: 04/30/2024 01:40:03 PM


Document Has Been Signed on 04/30/2024 01:40 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:J & S HOME CARE IIFACILITY NUMBER:
197602074
ADMINISTRATOR:SOFIA ALVAREZFACILITY TYPE:
740
ADDRESS:9950 WILBUR AVENUETELEPHONE:
(818) 886-4286
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY:6CENSUS: 5DATE:
10/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:SOFIA ALVAREZ- Administrator TIME COMPLETED:
02:20 PM
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On 10/12/23 Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. Upon arrival, LPA was greeted by the Administrator Sofia Alvarez and explained the reason for the visit. A tour of the physical plant was conducted at 10:20AM.

Kitchen: All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Sharp objects were stored in locked drawers and cabinets. LPA observed fully stocked first aid kit in the kitchen drawer. Laundry Area: located through the kitchen. Appliances observed to be in good repair. The door was locked and thus laundry detergents were inaccessible to residents.


Temperature: Facility maintains a comfortable temperature of 78 degrees Fahrenheit.
Surrounding Grounds: Entry/exits were observed to be locked. The outdoor area was clean and free of hazards. There is large deck with a patio table and chairs shaded for clients use in the backyard. Patio furniture observed to be in good repair with adequate seating for the residents.
Smoke Alarms and Carbon Monoxide: The fire extinguisher is located in the kitchen, observed to be fully charged and was purchased on 10/22/22. Bathrooms: LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. The hot water temperature measured at 114.8°F. LPA observed appropriate grab bar and non-skid mat. Bedrooms: There were four (4) bedrooms designated for residents' use. Two (2) bedrooms are private and one (2)shared. All bedrooms were clean, properly furnished and had sufficient lighting. Common Areas: This includes the living room dining areas were appropriately furnished and lighting was adequate. The garage: is being used for an extra storage and was observed to be locked.

No deficiencies issued during today’s visit. Report was signed and delivered and an exit interview was conducted

SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana AgbanTELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023
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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