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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197604143
Report Date: 03/08/2022
Date Signed: 03/08/2022 11:56:46 AM

Document Has Been Signed on 03/08/2022 11:56 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:HEADWAY HOUSE, INC.FACILITY NUMBER:
197604143
ADMINISTRATOR:LENA REINHOLDSFACILITY TYPE:
735
ADDRESS:8500 SHIRLEY AVENUETELEPHONE:
(818) 772-2266
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 6CENSUS: 2DATE:
03/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:18 AM
MET WITH:Lena Reinholds, LicenseeTIME COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Shira Stamps met with Licensee Lena Reinholds for an unannounced one (1) year Required visit for this facility. LPA arrived at 10:18 am and was greeted by caregiver, Elizabeth Licona Galleas and the Licensee. LPA informed the Licensee of the purpose of the visit.

Infection control: LPA reviewed the facility mitigation plan (approved on 04/14/21) to make sure the licensee was following current infection control recommendations. Upon arrival LPA was screened by the Caregiver, and sanitizer was available upon entry.

A tour of the physical plant was conducted with the Licensee at 10:32 am. The facility has four (4) bedrooms and two (2) bathrooms currently occupying two (2) clients. Two (2) bedrooms and one (1) bathroom are currently not being used by the clients. The facility is Fire Cleared for six (6) non ambulatory clients. The clients were observed resting and/or working on the computer.

Living and dining
At 10:32 am, LPA observed the living room to be neat and clean along with the dining room. The facility maintains a comfortable temperature at 74°F. The smoke detectors and carbon monoxide detectors were tested and observed to be operational at 10:52 am. There is one (1) fire extinguisher located near the entry door. The fire extinguisher was observed to be full and last serviced on 09/07/21. LPA observed the medications locked in a cabinet and inaccessible to client’s in care.

Food Inspection
LPA conducted a tour of the kitchen around 10:35 am and observed there to be sufficient stock of two-day perishables and seven-day non-perishables foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas care clean and inaccessible to pests. LPA observed all knives and chemicals/hazardous items locked in the cabinet under the sink.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2022
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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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: HEADWAY HOUSE, INC.
FACILITY NUMBER: 197604143
VISIT DATE: 03/08/2022
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Laundry/Garage
At 10:38 am, LPA observed the laundry room located in the garage. The Garage is attached to the facility and currently being used for extra storage, an extra refrigerator, and freezer. There were no chemicals/hazardous items located in the garage.

Physical environment
LPA toured the outside area of the facility at 10:40 am. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. No bodies of water on the premises.

Resident Rooms
At 10:42 am, LPA observed rooms to have the appropriate bedding. There is a nightstand and sufficient lighting for each resident. LPA observed extra bedding, sheets, and blankets in the hallway closet.

Bathrooms
At 10:45 am LPA observed all bathrooms to have non-skid matts and the appropriated wash your hands signs posted in the bathroom. LPA informed the Licensee to re-tape the sign since it had fallen down. Hot water was tested at 10:52 am and measured within regulation at 114.0 degrees F.

Administrative: The Licensee will send LPA the LIC.500 and the LIC9020. Annual fee is current.


An exit interview was conducted, and a copy of this report was given to the Licensee.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2022
LIC809 (FAS) - (06/04)
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