<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606909
Report Date: 04/12/2022
Date Signed: 04/12/2022 03:40:34 PM

Document Has Been Signed on 04/12/2022 03:40 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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:PEOPLE CREATING SUCCESS, INC. PCS-PARTHENIAFACILITY NUMBER:
197606909
ADMINISTRATOR:TANGA NUNNERYFACILITY TYPE:
735
ADDRESS:22005 PARTHENIA AVENUETELEPHONE:
(818) 715-0977
CITY:WEST HILLSSTATE: CAZIP CODE:
91304
CAPACITY: 5CENSUS: 3DATE:
04/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Tanga ShirleyTIME COMPLETED:
03:30 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) Wendell Smith conducted an unannounced annual visit in conjunction with a case management visit. LPA met with the administrator and explained the reason for this visit.
LPA conducted a physical plant tour. All smoke alarms were tested and function properly. There was a carbon monoxide detector at the facility. The fire extinguishers were observed to be fully charged and operational
Kitchen: The kitchen appeared clean and the appliances functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. LPA found knives and sharp objects stored in a locked closet. LPA found cleaning supplies in a locked cabinet under the sink. Properly labeled medications were locked in a closet in the dining area.

Bedrooms: There were four bedrooms designated for clients' use. All bedrooms were properly furnished and had appropriate bedding and linens.

Bathrooms: There were two bathrooms designated for clients' use. Both bathrooms were clean, properly supplied and had functional fixtures.

Common Areas: These included the living room and dining area. The common areas appeared clean and were properly furnished.

Surrounding Grounds: There was furniture appropriate for outdoor use and no visible hazards. The laundry area and detergents are in the locked garage. All passageways were free of obstruction. No deficiencies cited during this visit. Exit interview conducted.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1