197604832-9-14-2022-31-AS-ERIS-CJ9PHZ-20220914112047

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197604832
Report Date: 09/14/2022
Date Signed: 09/14/2022 11:21:02 AM

Document Has Been Signed on 09/14/2022 11:21 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	DISCOVERING HORIZONS-ODESSA		FACILITY NUMBER:	197604832
ADMINISTRATOR:	CYNTHIA KAWA		FACILITY TYPE:	735
ADDRESS:	8817 ODESSA AVENUE		TELEPHONE:	(818) 894-9301
CITY:	NORTH HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY: 6		CENSUS: 5	DATE:	09/14/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Rosalie Alejandro		TIME COMPLETED:	11:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPAs) Michael Cava and Evelin Rios conducted an Annual Required visit and inspection of the facility. LPA met with administrator Rosalie Alejandro and shortly after met with staff Sylvia Ruelas and explained the reason for the visit. At 9:30am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. The alarms are dual smoke and carbon monoxide detectors hardwired and interconnected functions properly. The fire extinguisher is located in the kitchen. The fire extinguisher was last serviced 03/07/2022. 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 cabinet in the kitchen. Cleaning supplies are kept in a locked cabinet in the kitchen. Office: Properly labeled medications were locked in a rolling cart in the office. Bedrooms: There were four (4) total bedrooms. Three (3) of the bedrooms, in use by clients were properly furnished with appropriate beddings and linens with sufficient lighting. One (1) of the bedrooms is designated for live-in staff. Bathrooms: There are Three (3) bathrooms total. Two (2) designated for clients' use. Both bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 110 degrees Fahrenheit. One (1) bathroom designated for live-in staff. Common Areas: These included the living room and dining area. The common areas were properly furnished.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: DISCOVERING HORIZONS-ODESSA	FACILITY NUMBER: 197604832
	VISIT DATE: 09/14/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Surrounding Grounds: Entry/exits were free of obstruction. The outdoor area was free of hazards. Then laundry detergents supplies are kept in a locked cabinet in the laundry room.

Resident Files: At approximately 10:30am, LPA reviewed client 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: Medication and Medication Records were review for proper documentation.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit.

Exit Interview Conducted / A Copy of the Report Issued.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2