197607838-12-9-2023-31-AS-TCAS-CYCSGC-20231209125144

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607838
Report Date: 12/09/2023
Date Signed: 12/09/2023 12:51:52 PM

Document Has Been Signed on 12/09/2023 12:51 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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	JL RESIDENTIAL CARE		FACILITY NUMBER:	197607838
ADMINISTRATOR:	JULITA T. / LOIDA QUIJANO		FACILITY TYPE:	735
ADDRESS:	7445 COZYCROFT AVENUE		TELEPHONE:	(818) 346-2009
CITY:	WINNETKA	STATE: CA	ZIP CODE:	91306
CAPACITY: 4		CENSUS: 4	DATE:	12/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Loida Quijano		TIME COMPLETED:	01:15 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) Tuesday Cabiness conducted a required annual visit/inspection for the facility. LPA was greeted by staff Glocidy Villaverde, who was informed the reason of the visit. Staff contacted Licensee/Administrator, Loida Quijano; who arrived later. She was also explained the reason for the visit. The current census is (4). Licensing and COVID signs were posted throughout the facility. All smoke alarms and carbon monoxide detector were tested and functioning properly. The fire extinguisher was charged; and first aid kit had Licensing requirements. Disaster drills are conducted quarterly, the last drill was conducted on 11/27/2023. Kitchen: The kitchen appeared clean and the appliances and fixtures functional. LPA found a sufficient amount of perishable and non-perishable food. Food was labeled and properly stored. There is an extra freezer located on the patio, stocked with food. Knives, sharp objects and medication are stored in a locked cabinet. Bedrooms: There were (3) bedrooms designated for clients' use. All bedrooms were clean, properly furnished and had appropriate bedding and linens. There is a staff room which is kept locked. Bathrooms: There were two bathrooms designated for clients' use. Both bathrooms were clean, properly supplied and had functional fixtures. Hot water temperature was measured at 110.4 degrees Fahrenheit. Cleaning supplies were stored in a locked cabinet in the bathroom. Common Areas: These included the living room and dining area. The common areas appeared clean and were properly furnished. Properly labeled medications were locked in a cabinet in the dining room.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2023

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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: JL RESIDENTIAL CARE	FACILITY NUMBER: 197607838
	VISIT DATE: 12/09/2023

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Surrounding Grounds: There was furniture appropriate for outdoor use and no visible hazards. The laundry area is on the porch in the backyard. LPA found detergents stored in a locked cabinet near the laundry area. The pool is properly secured. All passageways were free of obstruction. Exit gates were easily accessible.

Resident Records: Client files were reviewed which included admission agreements, medical assessments, personal rights documents, and current appraisals.

Cash Resources: Logs and cash resources were consistent and properly documented. Administrator counted client's funds in front of LPA.

Staff Records: Staff files included current CPR and first aid certifications and all staff have criminal record clearance and are associated to this facility.

Medications: Medications are consistent with the centrally stored medication log. No discrepancies observed.

No citations/ Exit Interview Conducted / A Copy of the Report Issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2023

LIC809 (FAS) - (06/04)

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