197607619-12-15-2023-31-AS-GSAO-CYJQZT-20231215113716

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607619
Report Date: 12/15/2023
Date Signed: 12/15/2023 11:37:29 AM

Document Has Been Signed on 12/15/2023 11:37 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	JMJ VALLEY HOMES INC.		FACILITY NUMBER:	197607619
ADMINISTRATOR:	MARISSA JARAVATA		FACILITY TYPE:	735
ADDRESS:	9514 GLADBECK AVENUE		TELEPHONE:	(818) 300-7949
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91324
CAPACITY: 4		CENSUS: 4	DATE:	12/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Marissa Jaravata		TIME COMPLETED:	11:45 AM

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At 8:40 a.m., Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, annual visit. LPA was met by Marissa Jaravata, the licensee/administrator.

LPA asked for the census, client, and staff rosters. LPA observed covid infection control signs at the entrance of the facility, facility sketch, activity schedule, staff schedule, disaster plan, house rules, client schedule, and personal rights.

Temperature of facility wall thermostat is observed and set to 69 degrees Fahrenheit.

The physical tour started at 09:50 am. The Garage is attached to the house from the laundry room area. The laundry room has a washer and dryer. The toxins are kept in the laundry area locked and secured in one of cabinets inaccessible to the clients. There is another cabinet in the laundry room area with extra linen. The garage has two refrigerators with extra food. The garage also has extra hygiene and the client property in separate bins.

Medications are in a cabinet locked and secured together with the first aid kit and manual. They are inaccessible to clients.

Backyard: There is a table set with umbrella and chairs for clients use. There is enough seating for four (4) clients There is no pool.

LIC 809C-continued

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2023

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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: JMJ VALLEY HOMES INC.	FACILITY NUMBER: 197607619
	VISIT DATE: 12/15/2023

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Living and dining room furniture is accessible for four (4) clients. There is a television and enough seating for four clients. There is internet accessibility a phone line available for client use. Furniture was observed to be in good condition and the fireplace has a covering around it.

Kitchen area was observed to be clean. The refrigerator is fully stacked and has the food menu. LPA reviewed the food service area, food storage and supply (perishable and nonperishable foods). The kitchen food supply was observed and sufficient for the four (4) clients currently residing there. There is an excess of perishables in several of the cabinets. The sharps are kept under the sink locked and inaccessible to the clients. There are several fire extinguishers throughout the house and smoke detectors. The latest fire extinguisher has a date of 03/2023 and fully charged. The smoke detectors were functioning properly.

There is a carbon monoxide detector is in the area against the wall by the kitchen sink.

Bedrooms: There are four (4) female clients living in the facility. There is three (3) client bedrooms. Two (2) clients bedrooms are single, occupied. One of the client rooms is shared. There are two (2) staff rooms. There are two bathrooms. One with a shower and one with no shower. The bathrooms read a temperature between 118.6 and 119.3 Fahrenheit. All bedrooms are properly furnished. The bathrooms have proper toiletry and grab bars.

Administrative: There is no annual fee due. The Infection Control Plan and the Emergency Disaster Plan are in a binder next to the client and staff rosters, surety bond and the Insurance plan.

An exit interview was conducted, no citations were issued, and a copy of this report was given to the administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2023

LIC809 (FAS) - (06/04)

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