197606437-10-20-2021-31-AS-ADUA-C7YS8K-20211020133916

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197606437
Report Date: 10/20/2021
Date Signed: 10/20/2021 01:39:25 PM

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:	CHATEAU ENCINO CARE, INC.		FACILITY NUMBER:	197606437
ADMINISTRATOR:	DANIEL BRAVO		FACILITY TYPE:	740
ADDRESS:	17732 ERWIN STREET		TELEPHONE:	(818) 342-6388
CITY:	ENCINO	STATE: CA	ZIP CODE:	91316
CAPACITY:	6	CENSUS: 1	DATE:	10/20/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Daniel Bravo, Administrator		TIME COMPLETED:	01:40 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) Abeye Duguma met with Administrator Daniel Bravo for a One (1) Year Required - Infection Control visit for this facility. LPA explained the reason for the visit. A tour of the physical plant was conducted at 10:15am and the following was noted: There is one entrance being utilized at the facility, there are required posters posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, infrared thermometer, hand sanitizer, gloves and masks are available. LPA was screened upon entry. All staff were observed to be wearing mask upon entrance and during visit. The facility has a submitted and approved Mitigation plan. Signs to wear a mask and other COVID 19 prevention protocol signs were posted outside the doors. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated visitors' area located in the front yard. The facility has enough stock of PPE in the storage room. The facility has six (06) bedrooms and eight (08) bathrooms currently occupying one (01) resident. The facility is fire cleared for zero (00) ambulatory, six (06) non-ambulatory and zero (00) bedridden residents. Living and dining room furniture were also checked. The living room is neat and clean along with the dining room. The facility maintains a comfortable temperature at 73°F. The smoke detectors are hardwired and interconnected and observed to be operational. There is a carbon monoxide detector installed at the facility. Fire extinguishers are in the kitchen and near the staff office. Both were observed to be full and last inspected on 09/14/2021. The facility is not equipped with fire sprinklers. (continued on LIC 809-C)

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021

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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CHATEAU ENCINO CARE, INC.	FACILITY NUMBER: 197606437
	VISIT DATE: 10/20/2021

NARRATIVE

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The backyard of the facility has outdoor furniture, with a covered shaded area for clients. There is a swimming pool in the facility located in the backyard (it was empty on inspection date). The swimming pool is gated and locked.

The garage is currently being used as a staff room. Laundry room is located adjacent to the kitchen. Laundry detergents, cleaning agents and other toxins are stored in a locked cabinet in the staff restroom located near the front door. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents.

The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lit. Clients have a sufficient amount of personal hygiene product provided by the licensee.

Staff Rooms: Staff room was observed to be locked, located on opposite ends of the hallway, adjacent to the formal dining area and the converted garage. No medications are observed in the staff room.

The bathroom was checked for cleanliness and proper operations. LPA observed the appropriate grab bars in the toilet and shower. The hot water temperature was measured at a range of 114.8°F to 115.9°F. Towels and washcloths are not shared. There was enough clean linen available stored in the cabinets.

Medications: LPA observed medication cabinet to be locked, inaccessible to residents and located near the Kitchen Nook. There is a complete first aid kit located inside the same medication cabinet.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021

LIC809 (FAS) - (06/04)

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