197606973-5-29-2024-31-AS-MCAA-D5QTRR-20240529145758

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197606973
Report Date: 05/29/2024
Date Signed: 05/29/2024 02:58:09 PM

Document Has Been Signed on 05/29/2024 02:58 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:	FEMMS RESIDENTIAL HOMES I		FACILITY NUMBER:	197606973
ADMINISTRATOR:	FRUCTUOSA M. MORALES		FACILITY TYPE:	740
ADDRESS:	11811 PASO ROBLES STREET		TELEPHONE:	(818) 217-4081
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 5	DATE:	05/29/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:02 PM
MET WITH:	Neil Morales		TIME COMPLETED:	03:00 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) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the administrator, Neil Morales and explained the reason for the visit. At approximately 12:15pm, with the assistance of the administrator, LPA took a tour of the physical plant. The facility is a one story building that houses clients age 60 and above. Required postings were observed in the entry area. The smoke alarms are hardwired and interconnected. The carbon monoxide detector is located by room #4. The fire extinguisher is located in the kitchen. It was purchased on 10/10/23. The fire drill was last conducted on February 13, 2024. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food sealed and properly stored. There were no knives or cleaning supplies out and accessible during the day's visit. Bedrooms: There were seven (7) bedrooms. Six (6) rooms designated for residents' use. All six rooms are private. One (1) bedroom is designated for staff use. Resident bedrooms were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are three (3) bathrooms. Two (2) are designated for residents' use, and one (1) for staff. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 111.6 degrees Fahrenheit. No cleaning supplies were observed stored in any of the resident bathrooms. Common Areas: These included the living room, family room and dining area. The living room has a couch, two chairs and television. There is a fireplace that is blocked and no tools were present. The family room has a couch and television. The dining room has a table to accommodate six (6). All furniture in common

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

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: FEMMS RESIDENTIAL HOMES I	FACILITY NUMBER: 197606973
	VISIT DATE: 05/29/2024

NARRATIVE

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areas were in good repair. The floors were mopped and clean. Hallways/passageways are clear of obstruction. The auditory alarms on all exit doors were on and functional at the time of the visit.

OFFICE/STAFF WORKSTATION: Staff workstation is located at the corner in the family room, by the back exit. Resident and staff files are maintained in a locked filing cabinet there.

Laundry area: The laundry area is located adjacent to the kitchen. Toxins and detergents not present at this time.

Garage: The garage is attached to the building. The only entry to the garage is through the side of the home. The garage has a freezer and a refrigerator. The garage is used as storage for extra perishable and non-perishable food. Entry to the garage is kept locked and inaccessible to the residents

Surrounding Grounds: Entry/exits were free of obstruction. There is a patio in the backyard with furniture appropriate for outdoor use. The outdoor area was free of hazards. The backyard has sufficient space to hold outdoor activities. There are two storage buildings in the back that stores extra beds and furniture. Both storage building were locked during the day's visit.

Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

Medications: Medications are stored in a locked cabinet in the kitchen. Medication and Medication Records were reviewed for proper storage and documentation.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC809 (FAS) - (06/04)

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