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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607838
Report Date: 03/29/2022
Date Signed: 03/29/2022 12:18:38 PM

Document Has Been Signed on 03/29/2022 12:18 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:JL RESIDENTIAL CAREFACILITY NUMBER:
197607838
ADMINISTRATOR:JULITA T. / LOIDA QUIJANOFACILITY TYPE:
735
ADDRESS:7445 COZYCROFT AVENUETELEPHONE:
(818) 346-2009
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY: 4CENSUS: 4DATE:
03/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Loida QuijanoTIME COMPLETED:
11:30 AM
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A Required One (1) year - Infection Control visit was conducted today by Licensing Program Analyst (LPA) Michael Cava. LPA met with the administrator, Loida Quijano and stated the purpose of the visit. LPA observed that all four (4) residents were at the facility during the visit.

The tour of the physical plant was conducted at 8:30am and the following were noted:

The main door is the only entrance being utilized for entry. There is a sign on the door that everyone entering at the facility must wear a mask and must be screened. The screening area is located near the entrance. Sign in sheet, hand sanitizer, gloves and masks are available. LPA was screened by staff upon entry. All staff were observed to be wearing a mask.

The facility submitted an approved Mitigation Plan.

Signs to wear a mask and other COVID 19 prevention protocol signs were posted on the walls. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted all over the facility. All trash cans were observed to be with covers.

The facility has a designated visitor's area in the living room or at the backyard. The facility has a sufficient supply of PPE in the storage room.

Resident rooms: The facility has a fire clearance for four (4) Ambulatory only. There are three (3) Resident rooms and one (1) room assigned to staff. Resident rooms have appropriate lighting, furniture, bedding, and linens.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2022
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 2
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: JL RESIDENTIAL CARE
FACILITY NUMBER: 197607838
VISIT DATE: 03/29/2022
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Bathrooms: LPA toured resident bathrooms and checked to make sure bathrooms were clean and in good repair. The hot water temperature measured at 108 degrees F. Towels and washcloths are not shared. Residents have sufficient amounts of supplies for personal hygiene items which is provided by the Licensee.

Common Areas: LPA toured the common areas of the facility. LPA observed common areas to be clean and furniture in good repair. The facility maintains a comfortable temperature at 72 degrees F. LPA observed a fire extinguisher maintained in the kitchen, that is fully charged. It was last checked on 5/17/21. The smoke/carbon monoxide detectors are operational. There are no issues with Fire Clearance.

Outside areas: LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. There is a swimming pool, that is fenced all around and at least five feet high. The fence was observed to have a self latching device, and is padlocked, making it inaccessible for residents.

The garage: Facility has no garage. Only a car port.

Food Inspection: LPA conducted a food inspection tour. LPA observed there to be sufficient stock of two-day perishable and seven-day non-perishables foods. Snacks and beverages are available for clients in the facility when they want. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Cleaning supplies, pesticides or toxins were stored and locked away.

Laundry: The laundry area is in the back yard. Cleaning supplies are stored and observed to be in locked cabinets. There is enough linen available to change weekly or more if need.

Pursuant to CA code of Regulations Title 22 or Health and Safety Code. No deficiencies observed during the day's visit. Exit interview conducted and a copy of this report provided.

**CONSISTENCY CHECK. PLEASE SEE HARD COPY FOR FACILITY REPRESENTATIVE SIGNATURE. **
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022
LIC809 (FAS) - (06/04)
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