197606622-2-25-2025-31-AS-LDLC-DE99DM-20250225221657

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197606622
Report Date: 02/25/2025
Date Signed: 02/25/2025 10:17:51 PM

Document Has Been Signed on 02/25/2025 10:17 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:	STANWIN RESIDENTIAL CARE		FACILITY NUMBER:	197606622
ADMINISTRATOR/ DIRECTOR:	MARY JANE C. MONTIANO		FACILITY TYPE:	735
ADDRESS:	9768 STANWIN AVENUE		TELEPHONE:	(747) 225-0382
CITY:	ARLETA	STATE: CA	ZIP CODE:	91331
CAPACITY: 6		CENSUS: 6	DATE:	02/25/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:30 PM
MET WITH:	MARY JANE C. MONTIANO, Licensee		TIME VISIT/ INSPECTION COMPLETED:	04:15 PM

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On 2/25/2025, Licensing Program Analyst (LPA) de la Cerra arrived at the facility at 12:30PM to conduct an unannounced annual inspection. LPA was greeted by licensee, Mary Jane Montiano and LPA informed licensee the purpose of the visit.

At approximately 1:00PM LPA and administrator toured the facility and the following was observed. The facility is a single-story building that consist of four (4) bedroom and two (2) bathrooms. LPA observed one (1) fire extinguisher, observed to be fully charged. LPA observed the required facility postings in the common area. The facility provides a telephone for clients to use and LPA observed the phone to be operational.

LPA observed dual smoke/carbon monoxide detectors that are hard wired and interconnected. Administrator tested the dual smoke/carbon monoxide detector @1:22PM and was observed to be operational.

Bedrooms: There are three (3) bedrooms designated for clients to use and have sufficient lighting. All bedrooms are furnished with a night stand, a chair, a lamp, a closet and a bed with clean bedding and linens.

Bathrooms: Bathrooms: LPA observed two (2) bathrooms that are in good repair. LPA observed the functional and appropriate fixtures. The hot water temperature measured between 108°- 110°F. LPA observed the appropriate grab bars and non-skid mat by the toilet and in the shower area for one of the bathrooms. LPA also observed the other bathroom by the kitchen area needed a new non-skid mat in the shower area.

Common Areas: The living room appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025

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: STANWIN RESIDENTIAL CARE	FACILITY NUMBER: 197606622
	VISIT DATE: 02/25/2025

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Laundry Area: LPA also observed the washer and dryer located outside in the kitchen area which appears to be in good condition. LPA also observed a locked cabinet that stores laundry detergents and some cleaning solutions,

Surrounding grounds: No bodies of water was observed. LPA observed a seating area with shade available for clients to use. LPA observed a locked shed which is inaccessible to clients and it is used as an additional storage for supplies and clients' personal items.

Facility Records: At 1:45PM LPA conducted review of clients’ records and staff records. LPA reviewed clients' P&I records.

LPA reviewed six (6) out of six (6) client records and two (2) staff records to ensure compliance. The facility files were kept in locked cabinet located in the kitchen area.

Medications: The medications were kept in locked cabinet in the kitchen area and is inaccessible to clients in care. The first-aid kit is complete.

At approximately 3:00PM medications and medication records were reviewed for proper documentation. Centrally Stored Medication Records are pre-filled by pharmacy and facility keeps a Medication Administration Record (MAR).

Administrative: LPA requested for copies of the following; liability insurance, surety bonds, administrator certificate and LIC 500 to be submitted to LPA by 5:00PM on 02/25/2025.

No deficiencies cited during today's visit. Technical advisory was provided and a copy of this report, was provided to the administrator

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025

LIC809 (FAS) - (06/04)

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