197603491-7-31-2024-31-AS-NRED-D7PUZ2-20240731160048

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197603491
Report Date: 07/31/2024
Date Signed: 07/31/2024 04:01:17 PM

Document Has Been Signed on 07/31/2024 04:01 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:	AMIGO HOME II		FACILITY NUMBER:	197603491
ADMINISTRATOR/ DIRECTOR:	ELIZABETH BIJOU		FACILITY TYPE:	735
ADDRESS:	23601 VANOWEN STREET		TELEPHONE:	(818) 888-1983
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY: 6		CENSUS: 6	DATE:	07/31/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:10 PM
MET WITH:	Liz Bijou		TIME VISIT/ INSPECTION COMPLETED:	04:15 PM

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At 1:15 p.m. on 07/31/24, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and later the administrator and disclosed the reason for the visit. LPA and staff toured the facility inside and out.

The facility was last visited on 07/07/23 for an annual visit. It is a single story building with four (04) bedrooms, one (01) bathroom, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for six (06) ambulatory residents.

The main entrance was maintained and had seating arrangements in good repair. Postings were observed near the kitchen for the facility license, weekly menu, facility sketch, resident rights, emergency disaster plan, and house rules.

Walls, floors, windows, screens, and blinds were clean and in good repair. At 1:25 p.m. LPA measured the room temperature to be 80 degrees Fahrenheit. At 1:30 p.m. the house telephone was called and determined to be operational. At approximately 1:40 p.m. LPA observed a fully charged fire extinguisher in the kitchen. It was purchased on 07/17/2023. A Technical Violation is issued for the facility to purchase a new extinguisher annually or apply for an inspection of the current extinguisher. The living room contained reading material, holiday décor, television, an appropriately grated fireplace, and furniture in good repair. At approximately 1:55 p.m., smoke and carbon monoxide detectors were tested and operational.

The facility has four (04) bedrooms. One (01) bedroom is designated as a staff room. The staff room was free of hazards. All bedrooms contained a chair, lamp, nightstand, storage, and a bed with adequate bedding. All furnishings were clean and in good condition.

The facility has one (01) bathroom. The bathroom contained liquid soap, paper towels, a trash can with a tight fitting lid, and a non-skid mat in the shower. At approximately 2:10 p.m. LPA measured the water temperature to be 107.9 degrees Fahrenheit.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024

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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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: AMIGO HOME II	FACILITY NUMBER: 197603491
	VISIT DATE: 07/31/2024

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LPA observed an adequate supply of perishable and non-perishable foods in the kitchen refrigerators and pantry. Food was labelled and dated. Appliances were in good condition. Sharps and cleaning solutions were locked in a cabinet near the laundry area. Medications were locked in a cabinet near the bathroom. A washing machine and dryer were located adjacent to the kitchen. Both were in working order.

LPA observed a covered patio area in the rear of the facility. The patio contained furniture in good condition, a gas grill, and exercise equipment. Two (02) out of two (02) emergency exit paths were free from obstructions. Exit gates were unlocked with self-closing latches. The rear exit gate latch stuck upon initial attempts to open. A Technical Violation is issued to repair the latch. Evacuation routes were posted. The garage was locked and contained extra supplies.

During today's inspection, the facility was in compliance with Title 22 regulations. No immediate health and safety risks were observed during today’s visit.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024

LIC809 (FAS) - (06/04)

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