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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197602537
Report Date: 11/30/2023
Date Signed: 11/30/2023 01:02:18 PM


Document Has Been Signed on 11/30/2023 01:02 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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:MCLENNAN M. MANORFACILITY NUMBER:
197602537
ADMINISTRATOR:MORENO, LALAINE P.FACILITY TYPE:
740
ADDRESS:8844 MCLENNAN AVE.TELEPHONE:
(818) 892-8882
CITY:NORTHRIDGESTATE: CAZIP CODE:
91343
CAPACITY:6CENSUS: 4DATE:
11/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lalaine MorenoTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Tuesday Cabiness an Annual Required visit and inspection of the facility. LPA met with Administrator Lalaine Moreno, and staff, and explained the reason for the visit.

LPA took a tour of the physical plant. LPA observed no COVID postings throughout the walls of the facility. The Administrator reported to LPA, that because there is no longer an issue, they removed the signs. LPA suggested, that due to the recent rising in COVID cases, to attempt to post some signs, informing visitors, that they need to be mindful and careful when visiting and to ensure they are safe when visiting residents. Facility has fire extinguishers fully charged.

Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of properly stored perishable and non-perishable food at the facility. There is also an extra supply of perishable and non-perishable food in the garage. Knives are kept inaccessible from clients in a locked drawer.

Bedrooms: There were (4) bedrooms designated for residents' use. The resident bedrooms were properly furnished with appropriate beddings and linens with sufficient lighting.

Bathrooms: There are (2) bathrooms designated for residents' use. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 119.8 degrees Fahrenheit. No cleaning supplies observed in resident bathrooms.

Common Areas: These included the living/dining/and kitchen area. The common areas were properly furnished. Furniture in both the living room and dining area were clean and in good repair. Floors were also clean and presented no tripping hazard.
SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2023
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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: MCLENNAN M. MANOR
FACILITY NUMBER: 197602537
VISIT DATE: 11/30/2023
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Entry/exits were clear of obstruction. There is a fire place which that is covered and not being used.

Outside areas: LPA toured the outside area of the facility. LPA also observed a clean covered patio and backyard furniture to accommodate the residents.

The garage: Laundry area is in the attached garage and kept locked and inaccessible to residents. Extra PPE supplies and food storage was also observed.

Smoke detectors/carbon monoxide. Dual smoke and carbon monoxide detectors were located throughout the facility and observed to be operational.

Record Review (Staff & Residents): All required documents in resident and staff files. Medication review: no errors observed.


No citations issued during this visit. Exit interview conducted. Copy of report issued.

SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
LIC809 (FAS) - (06/04)
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