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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197605589
Report Date: 04/19/2023
Date Signed: 04/19/2023 12:12:08 PM

Document Has Been Signed on 04/19/2023 12:12 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:RAWATES INC.FACILITY NUMBER:
197605589
ADMINISTRATOR:SUJATA RAWATEFACILITY TYPE:
735
ADDRESS:20131 LABRADOR STREETTELEPHONE:
(818) 718-7806
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY: 5CENSUS: 5DATE:
04/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Suajata Rawate-Administator TIME COMPLETED:
12:40 PM
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Licensing Program Analysts (LPAs) Mariana Agban and Angela Panushkina arrived at the facility to conducted an unannounced annual inspection. Upon arrival LPAs was greeted by staff. LPAs later met with Administrator Sujata Rawate. This is a level four (4-I) care facility. At 9:45 a.m. a physical tour of the facility was conducted and the following was observed:

Infection Control: Covid-19 infection control signage were observed outside of the facility. Proper signage was also observed inside in the common areas. Facility has sufficient PPE supplies for more than 30 days. High traffic areas are cleaned and sanitized frequently. Food Inspection: The kitchen area was sufficiently stocked with two-day perishable and seven-day nonperishable. The facility has a waiver to lock all food do to the clients disability. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers in the kitchen. Sharps, cleaning supplies and medications are centrally stored in a locked area. Fire extinguisher is located in the kitchen and it was last serviced on 01/23/2023. Common Areas: All common areas were observed to be clean and properly furnished. Facility maintains a comfortable temperature of 72.0 F. Clients Rooms: Facility has five (5) bedrooms all designated for client use. All five (5) bedrooms were toured and appear to be clean and properly furnished. LPAs observed additional bedding and linens sufficient for all of the clients. Towels are not shared. All rooms have adequate lighting. Facility has awake staff. Bathrooms: There are three (3) bathrooms in the facility. LPAs observed all bathrooms to have grab bars and non-skid mats. At 10:30 a.m. the hot water was tested and measured at 108.2 F. All trash cans located in the bathrooms had tight fitting lids. Garage: There is a detached garage in the back of the house that is maintained locked and inaccessible to clients. Garage is used for storage and additional emergency food supplies. Smoke detectors/carbon monoxide are located throughout the facility and are hardwired. Smoke detectors and carbon monoxide detectors were tested at approximately 11:00 a.m. and appear to be functional.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2023
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: RAWATES INC.
FACILITY NUMBER: 197605589
VISIT DATE: 04/19/2023
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LPAs reviewed client files at approximately 11:10am. All client files included current appraisals, medical assessments, personal rights documents and initial appraisals. Clients P&I records reviewed and balanced. LPA reviewed files for all staff regularly scheduled at the facility. Staff files included current first aid certifications and all have criminal record clearance and are associated to this facility. Documentation of staff training reviewed and observed to be sufficient.

Licensee is in compliance with the California Code of Regulations (CCR.

Exit interview conducted and copy of this report signed and issued to the Administrator.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023
LIC809 (FAS) - (06/04)
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