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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197606329
Report Date:
11/01/2022
Date Signed:
11/01/2022 11:06:32 AM
Document Has Been Signed on
11/01/2022 11:06 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
CCLD Regional Office
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
PARK PLACE RESIDENTIAL CARE
FACILITY NUMBER:
197606329
ADMINISTRATOR:
MARIA ALVIR
FACILITY TYPE:
735
ADDRESS:
10401 DENSMORE AVENUE
TELEPHONE:
(818) 920-1084
CITY:
GRANADA HILLS
STATE:
CA
ZIP CODE:
91344
CAPACITY:
6
CENSUS:
6
DATE:
11/01/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
10:00 AM
MET WITH:
Maria Alvir/ Administrator
TIME COMPLETED:
11:25 AM
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Licensing Program Analyst (LPA) Patrick Shanahan arrived at the home in order to conduct an infection control annual inspection. The LPA was greeted by facility staff and had his temperature taken and COVID-19 questions asked before being allowed entry. The Administrator was called and arrived a short while later.
The inspection tool was used to conduct the annual. The LPA was also able to briefly tour the home. The home consists of 5 bedrooms and 2 bathrooms. The smoke alarms and carbon monoxide detectors were tested and functioned properly. A fire extinguisher was observed in the kitchen and appeared to be functional.
The Home is currently following their infection control plan and no deficiencies were observed during the visit.
Exit interview conducted and report issued.
SUPERVISORS NAME
:
Nichelle Gillyard
LICENSING EVALUATOR NAME
:
Patrick Shanahan
LICENSING EVALUATOR SIGNATURE
:
DATE:
11/01/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/01/2022
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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