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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197604691
Report Date: 12/14/2024
Date Signed: 12/14/2024 11:29:55 AM

Document Has Been Signed on 12/14/2024 11:29 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:ANGIE'S HOME CARE, INC.FACILITY NUMBER:
197604691
ADMINISTRATOR/
DIRECTOR:		HEATH, ANGELAFACILITY TYPE:
740
ADDRESS:16456 LOS ALIMOS STTELEPHONE:
(818) 366-7906
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 4TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
12/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:33 AM
MET WITH:Angela HeathTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the administrator, Angela Heath and explained the reason for the visit.

At approximately 8:45am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. The facility is a one story building. The smoke alarms and carbon monoxide detector are connected and functional. The fire extinguisher is located in the kitchen. It was last charged April 24, 2024.

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 were stored in a locked.

Bedrooms: There are six (6) bedrooms of which four (4) are for the resident's use. Two (2) bedrooms are designated for staff use. The bedrooms, in use by residents were properly furnished with appropriate beddings and linens with sufficient lighting. Staff rooms are locked. No medications are observed in the staff room.

Bathrooms: There are three (3) bathrooms of which, two (2) are designated for residents' use. Both bathrooms were properly supplied and had functional fixtures. One (1) bathroom is designated for staff use. Hot water temperature was measured between 115 and 120 degrees Fahrenheit. LPA did not observe any cleaning supplies in the resident bathrooms during the day of the annual.

Common Areas: These included the living room and dining area. The living room has two couches and up to four additional seating. There is a fireplace, that is non-functional. The dining room has a table large enough to seat the four residents. The auditory alarms on all exit doors were on and functional at the time of
Eva MillerTELEPHONE: (818) 596-4373
Michael CavaTELEPHONE: (818) 389-7921
DATE: 12/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2024
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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ANGIE'S HOME CARE, INC.
FACILITY NUMBER: 197604691
VISIT DATE: 12/14/2024
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the visit. Furniture was observed in good repair. Floors were mopped and clean. Passageways were clear of obstruction.

Surrounding Grounds: Back and front yards were free of any hazards. There was furniture appropriate for outdoor use.

The garage: Garage is attached to the home but locked and inaccessible to residents. It is also being used as the laundry area. Laundry detergents, cleaning solutions and other toxins are stored in the garage.

Resident Files: 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.

Medications: Medications are stored locked in a hallway closet. Medication and Medication Records were reviewed for proper storage and documentation. First aid kit is equipped with necessary tools and supplies.

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: 12/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2024
LIC809 (FAS) - (06/04)
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