197606308-7-18-2023-31-AS-SURA-CTUTJ8-20230718144555

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197606308
Report Date: 07/18/2023
Date Signed: 07/18/2023 02:46:42 PM

Document Has Been Signed on 07/18/2023 02:46 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
CCLD Regional Office,
, CA

FACILITY NAME:	ENRICHMENT AND SOCIAL OPPORT. FOR LIFE SKILLS		FACILITY NUMBER:	197606308
ADMINISTRATOR:	MARGIE RHYNE, MICHAEL STEP		FACILITY TYPE:	775
ADDRESS:	7711 JELLICO AVENUE		TELEPHONE:	(818) 881-4427
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY: 14		CENSUS: 11	DATE:	07/18/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Michael Stephens		TIME COMPLETED:	03:00 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 (LPA) Sandra Urena conducted an unannounced Annual/Required visit. Upon arrival LPA met with administrators Margie Rhyne and Michael Stephens. The purpose of the visit was explained.
At 11:00 a.m. the LPA and the administrator conducted a tour of the physical plant. The main house is located in the front of the property, and consists of a kitchen area, two (2) bathrooms, two large activity rooms and an office/computer room
KITCHEN: The kitchen area has two functional refrigerators, and a stove. Water was measured at 105.2 degrees F. Facility does not offer any meals at the moment. The fire alarm and carbon monoxide alarm were tested and were functional. Fire extinguisher has a service date of 03/30/2023. The emergency kit is located in the kitchen area.

COMMON AREAS: At the time of the visit, the activities rooms were observed to be in good condition. The facility maintained a comfortable temperature of 76 degrees. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguishers were fully charged and were last serviced 03/303/2023. The LPA observed required postings in the main meeting room.

RESTROOMS: The two client restrooms were clean and insanitary and in operating condition. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature measured in the hallway restroom at 105.8 degrees Fahrenheit.

Continues on LIC 809C...

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

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
CCLD Regional Office,
, CA

FACILITY NAME: ENRICHMENT AND SOCIAL OPPORT. FOR LIFE SKILLS	FACILITY NUMBER: 197606308
	VISIT DATE: 07/18/2023

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

OUTDOOR: The facility has several structures addition to the main house. The LPA observed two offices, a temporary storage area for supplies, and a garage area where additional tools and chemicals were stored. Facility has a shaded patio area for clients. An additional outdoor area where gardening activities were provided to clients is no longer accessible to clients as the gardening activities are no longer offered. The gate leading to the gardening area is locked.

The facility is currently operating as a community based program. Per the administrator, the facility has been operating as a community based program for the last two years. The community based program consist of clients being dropped off at the facility in the mornings between 7:00 a.m. and 8:00 a.m., clients are then bus to community programs activities being offered throughout the community. The administrator provided a sample of two activities calendars. Clients do not return to the facility after the community activities are completed. At the moment, the facility does not offer any client activities at the facility.

RECORDS: Residents’ records review began at 1:30 p.m. records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. Individual Program Plans (IPP). All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate trainings. All files were in order.

Clients are not currently taking any medication; therefore, facility is not in possession of any medication.

INFECTION CONTROL: Upon entry of the kitchen , the facility has a central entry point for symptom screening, temperature checks, and a sanitation station. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient.

The LPAs obtained the following documents:

- LIC500 Personnel Report
- LIC9020 Client Roster
- Activities Calendar

No deficiencies issued. Exit interview conducted. Report was issued.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Sandra Urena
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2