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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607619
Report Date: 11/21/2022
Date Signed: 11/21/2022 11:30:17 AM

Document Has Been Signed on 11/21/2022 11:30 AM - 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:JMJ VALLEY HOMES INC.FACILITY NUMBER:
197607619
ADMINISTRATOR:MARISSA JARAVATAFACILITY TYPE:
735
ADDRESS:9514 GLADBECK AVENUETELEPHONE:
(818) 300-7949
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 6CENSUS: 4DATE:
11/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Marissa Jaravata, AdministratorTIME COMPLETED:
01:00 PM
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LPA, Panushkina conducted an unannounced annual visit to the facility at 10:00am. Upon approaching the facility, LPA observed the COVID signs on the door. LPA was greeted by the Administrator who was wearing a mask and LPA stated the purpose of the visit. Administrator confirmed there are four clients within the facility. LPA's temperature was taken and LPA answered the COVID questions at the sign in station. LPA observed thermometer, hand sanitizer and sign in sheet at the sign in station.

LPA and Administrator began tour at 10:15am. LPA observed the living room contained comfortable seating. The dining room contained dining room table and dining chairs. The kitchen was clean. LPA observed the refrigerator was stocked with a two-day supply of fresh fruits and vegetables. The pantry was stocked with a seven-day supply of canned good items. LPA observed the knives were locked underneath the sink. The kitchen sink area contained wash your hands sign, hand soap, and a trash can with a covered lid. The medications were locked in the kitchen cabinet. LPA also observed a fire extinguisher that was last purchased on 01/23/2022. At 10:30am, LPA observed the client's bedrooms contained bed, linens, lamp, night stand, and chest of drawers. All rooms were neat and clean. At 11:15am, smoke alarms and carbon monoxide were tested and observed to be functioning.

LPA observed the two bathrooms contained the required wash your hands sign, hand soap, paper towels, and trash cans in each bathroom. Hot water temperature measured at 120-degrees Fahrenheit. LPA was then escorted to the garage and LPA observed a refrigerator which contained fresh vegetables, frozen meats and vegetables, canned goods, PPE supplies such as face shields, surgical gowns, and gloves. The backyard contained a shaded area with comfortable seating. The side gates that lead from the backyard to the front yard were not locked.

There are no deficiencies to report at this time. Exit interview was conducted, appeal rights discussed, and a copy of the report was given to the Administrator.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2022
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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