197606308-6-17-2024-31-AS-GSAO-D6BSLP-20240617135841

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197606308
Report Date: 06/17/2024
Date Signed: 06/17/2024 01:59:33 PM

Document Has Been Signed on 06/17/2024 01:59 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:	ENRICHMENT AND SOCIAL OPPORT. FOR LIFE SKILLS		FACILITY NUMBER:	197606308
ADMINISTRATOR/ DIRECTOR:	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: 10	DATE:	06/17/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:45 AM
MET WITH:	Jason Walker, Director		TIME VISIT/ INSPECTION COMPLETED:	02:15 PM

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On 06/17/24, at 9:45 am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, annual visit. LPA was met by Jason Walker, Director.

LPA asked for the census, participant, and staff files.

The physical tour started at 11:25 am and LPA observed the following:

Common Areas: At approximately 11:25am, LPA and Director toured the facility. There is two (2) large activity rooms and a great room which is also used as an activity room next to the kitchen. LPA observed proper tables and chairs for the participants. All trash cans were observed to have lids. The facility maintains a temperature at 72 Fahrenheit.

The bathrooms: LPA observed two (2) bathrooms to be clean and have the wash your hands signs posted. One (1) of the bathrooms has a shower area that can be used for the participants. The other bathroom has a washer and dryer to wash the clothes used for cleaning. The bathroom that has a shower has grab bars. The hot water temperature tested in the bathroom is with in required range between 115 Fahrenheit. Trash cans in all bathrooms have lids.

There are two (2) fire extinguishers observed to be full and last serviced on 03/2024. One (1) is located by the great room and the other one (1) is located in the kitchen entrance on your right hand side.

809C-continued

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2024

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

FACILITY NAME: ENRICHMENT AND SOCIAL OPPORT. FOR LIFE SKILLS	FACILITY NUMBER: 197606308
	VISIT DATE: 06/17/2024

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Kitchen area: The First Aid kit and manual was observed to be complete. It is located in the kitchen area on your left hand side of the entrance by the refrigerators. There are two (2) refrigerators and one (1) Emergency Food Storage area. LPA observed the kitchen area to be adequately clean. The facility does not keep any food for participants. The participants bring their own breakfast/lunch/dinner. There are knives are kept in a metal cabinet on your left-hand side inaccessible and locked away from the participants.

The chemicals are kept outside by the kitchen area locked and inaccessible away from the participants.

Medications: There are no medications that are kept at this facility.

There are several exit doors. There is no transportation vehicles. The participants are taken out by public transportation out to the community. There are several smoke detectors and carbon monoxides through out the facility.

Outdoor/Backyard: The facility has several structures addition to the main house. There is a garage area where additional tools and chemicals are stored. Facility has a shaded patio area for participants. An additional outdoor area is at the front of the facility. The facility is currently operating as a community based program. The community based program consist of participants being dropped off at the facility in the mornings between 7:00am and 7:30am.

Administration: The Infection control were reviewed and there was Covid 19 signs on the wall, hygiene sanitation signs, Emergency and Disaster Plan, Personal Rights, YES sign were observed in the great room on your left-hand side and the last fire drill was conducted May 28th, 2024. The insurance plan is up to date and expires 03/01/2025.

An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the Director.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2024

LIC809 (FAS) - (06/04)

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