197606973-10-14-2023-31-AS-MCAA-CWLURW-20231014154924

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197606973
Report Date: 10/14/2023
Date Signed: 10/14/2023 03:49:58 PM

Document Has Been Signed on 10/14/2023 03:49 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: 6	DATE:	10/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:01 PM
MET WITH:	Neil Morales		TIME COMPLETED:	04:00 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 1:01pm, with the assistance of the administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are hardwired and interconnected. There are carbon monoxide detectors that functions properly. The fire extinguisher is located in the kitchen. It was purchased on 10/10/23. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets. 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 110.4 degrees Fahrenheit. No cleaning supplies were observed stored in resident bathrooms. Common Areas: These included the living room and dining area. The common areas were properly furnished. There are two living rooms. The dining area has a large dining room table to accommodate six (6). The auditory alarms on all exit doors were on and functional at the time of the visit.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2023

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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: FEMMS RESIDENTIAL HOMES I	FACILITY NUMBER: 197606973
	VISIT DATE: 10/14/2023

NARRATIVE

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OFFICE/STAFF WORKSTATION: Staff workstation is located by one of the living rooms. Resident and personnel files are maintained in a locked filing cabinet there.

Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor
use. The outdoor area was free of hazards. The laundry area and detergents are located by the kitchen. Detergents and cleaning supplies stored separate and away from the non-perishable food. Detergents and cleaning supplies were locked in a cabinet.

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: Medication and Medication Records were review for proper 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: 10/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2023

LIC809 (FAS) - (06/04)

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