197606758-8-29-2023-29-AS-SURA-CV6VDX-20230829162127

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197606758
Report Date: 08/29/2023
Date Signed: 08/29/2023 04:22:52 PM

Document Has Been Signed on 08/29/2023 04:22 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	CHATEAU OF OAKS		FACILITY NUMBER:	197606758
ADMINISTRATOR:	ROLANDO & LILY LAZATIN		FACILITY TYPE:	740
ADDRESS:	15239 CAMARILLO STREET		TELEPHONE:	(818) 510-0080
CITY:	SHERMAN OAKS	STATE: CA	ZIP CODE:	91403
CAPACITY:	6	CENSUS: 4	DATE:	08/29/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:12 PM
MET WITH:	Rolando Lazatin		TIME COMPLETED:	04:30 PM

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Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual inspection. LPA Urena was greeted by staff. The Administrator Rolando Lazatin arrived shortly thereafter, and the LPA explained the reason for the visit.

At 01:15 p.m., LPA Urena, and the administrator conducted a tour inside, and outside the facility to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

KITCHEN: Knives are stored in a locked cabinet drawer. Kitchen appliances were in operable condition. The facility has enough supply of perishable and non-perishable food. Freezer and refrigerator are stocked with a variety of foods. Emergency food supply is adequate for six residents and two staff. Toxic materials are locked, and out of reach of residents.

BEDROOMS: Four bedrooms were observed to be furnished appropriately with appropriate furnishings and sufficient lighting. Linens are clean and in good condition. Extra linens were observed in the hallway cabinet.

COMMON AREAS: The common seating area, and dining room furniture was observed to be clean and in good condition. Fire extinguisher was observed to be serviced within the last year. The walls and flooring were observed to be clean and in good condition.

Continues on LIC 809C…

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: CHATEAU OF OAKS	FACILITY NUMBER: 197606758
	VISIT DATE: 08/29/2023

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BATHROOM: Bathrooms were observed to be clean; shower area was in clean condition with grab bars, and a non-skid mat available. Paper towels were available for drying hands. Hand washing signs were displayed, and enough soap, and paper products in each restroom.

OUTDOOR: Backyard has a patio area and has patio shade umbrella and patio furniture for residents’ use. No open bodies of water were noted.

RECORDS: Records review began at 2:30 p.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. 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 annual training. All files were in order.

MEDICATIONS: Medications review began at 3:30 p.m.; medications are centrally stored and locked in a cabinet in the kitchen area; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors were observed during the medication review.

INFECTION CONTROL: 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. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19.

The LPA obtained the following documents:

- LIC500 Personnel Report
- LIC9020 Client Roster

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023

LIC809 (FAS) - (06/04)

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