197604832-10-20-2023-31-AS-LNCA-CWSTGL-20231020144318

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197604832
Report Date: 10/20/2023
Date Signed: 10/20/2023 02:43:30 PM

Document Has Been Signed on 10/20/2023 02:43 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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	DISCOVERING HORIZONS-ODESSA		FACILITY NUMBER:	197604832
ADMINISTRATOR:	MONTIQUE JOHNSON		FACILITY TYPE:	735
ADDRESS:	8817 ODESSA AVENUE		TELEPHONE:	(818) 894-9301
CITY:	NORTH HILLS	STATE: CA	ZIP CODE:	91343
CAPACITY: 6		CENSUS: 6	DATE:	10/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Montique Johnson(Administrator)		TIME COMPLETED:	02:45 PM

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) Leslie Ngo-Castaneda and Huma Rahimi with License Program Manager LPM Nichelle Gillyard arrived at (time) and met with Sylvia Ruelas for an annual visit. The administrator Montique Johnson was contacted and appeared for the visit at 9:45am. At approximately 9:45 am team conducted a tour of the facility with the administrator and the following was observed: Common Areas: Team toured all common areas of the facility. LPAs observed common areas to be very clean and tidy. LPAs and LPM observed the floors to be in very good condition. No obstructions and or tripping hazards throughout the facility. Furniture in common area was observed to be in good repair. The facility maintains a comfortable temperature at 72 degrees Fahrenheit. LPAs observed fire extinguishers throughout the facility to be full and serviced 4.19.2023. The smoke/carbon monoxide detectors are operational. There are no issues with Fire Clearance. Infection control: LPAs and LPM reviewed facility mitigation plan to make sure licensee was following current infection control recommendations. LPA obtain a copy and reviewed the infection control plan during this visit. Food Inspection: LPAs conducted a food inspection tour. LPAs observed there to be sufficient stock of two day perishable and one week of non-perishable foods. The menu was posted for review (ARF), snacks and beverages are available for the resident in the facility when they want. LPA requested and advised administrator that all meal periods(breakfast, lunch, dinned, 2 snack) be included on the menu. Frozen foods are properly wrapped and stored appropriately and dated. Food storage and preparation areas are clean and inaccessible to pests. Continue to LIC 809-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2023

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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: DISCOVERING HORIZONS-ODESSA	FACILITY NUMBER: 197604832
	VISIT DATE: 10/20/2023

NARRATIVE

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Garbage cans have tight fitting covers. Cleaning supplies, pesticides or toxic cleaning supplies were stored and locked away. LPAs discussed special diets for diabetic resident.

Resident room: Team toured all 4 resident rooms. LPA observed rooms to have appropriate bedding sheets, pillowcase and blankets which are in good and adequate condition. Team requested that mattress pads be placed on all beds. There is at least one chair, night-stand and sufficient lighting for each client. The mattresses and bedsprings were also checked for condition.

Bathrooms: LPAs toured resident bathrooms and checked to make sure bathrooms were clean and in good repair. The hot water temperature measured at 119F. LPAs observed appropriate grab bars each bathroom. Towels and washcloths are not shared. Residents have sufficient amounts of supplies for personal hygiene which is provided by the licensee.

Outside areas: LPAs toured the outside area of the facility. LPAs observed appropriate outdoor furniture, with a covered shaded area for clients. There are no bodies of water which is unsecured. The garage is attached to the home and is kept locked inaccessible to clients.
Laundry service: There is enough linen available to change weekly or more if need.

Medications are in a centrally stored and locked place, including over-the-counter medicines; medications are properly labeled and checked for expiration dates. Each centrally stored prescription and PRN medication has been logged in the medications log with proper documentation from the clients’ doctor. Proper medication dispensing instruction are followed and checked for contamination. First-aid has all proper items and is current.

Resident records were reviewed for requirements and legibility: LPAs and LPM reviewed client’s files for current IPP’s and surety bonds (LIC 402) a copy was handed to LPAs. Planned activities are offered. Type V (technical violation) has been issued to administration for R6 has incomplete files from Regional Center for missing MD report, admission agreement, preplacement, and functional capacity. LPAs and LPM gave administrator 10 days for documents to be sent to LPA. Team reviewed two out of six residents funds and observed receipts and funds balanced.
Continue to LIC 809-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: DISCOVERING HORIZONS-ODESSA	FACILITY NUMBER: 197604832
	VISIT DATE: 10/20/2023

NARRATIVE

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Personnel records were checked for expired or missing certificates and clearances: LPAs conducted a file
review of staff for criminal record clearances and current First Aid. The administrator file was reviewed for current first aid, fingerprint clearance, administrator certificate, and HIV/AIDS and TB training.

Facility is within CA code of Regulations Title 22 or Health and Safety Code. No deficiencies were found, exit interview conducted, copy of report has been issued and discussed.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

LIC809 (FAS) - (06/04)

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