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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607838
Report Date: 11/18/2024
Date Signed: 11/18/2024 01:21:26 PM

Document Has Been Signed on 11/18/2024 01:21 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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:JL RESIDENTIAL CAREFACILITY NUMBER:
197607838
ADMINISTRATOR/
DIRECTOR:		JULITA T. / LOIDA QUIJANOFACILITY TYPE:
735
ADDRESS:7445 COZYCROFT AVENUETELEPHONE:
(818) 346-2009
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY: 4CENSUS: 4DATE:
11/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Loida Quijano, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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At 9:45 AM Licensing Program Analyst (LPA), Huma Rahimi, conducted an unannounced annual inspection at the facility mentioned above. LPA was greeted by staff Cedenia Montejo, who was informed the reason of the visit. Staff contacted the Administrator, Loida Quijano; who arrived shortly after. She was also explained the reason for the visit. Physical tour was conducted with the Administrator and LPA observed the following:

The fire extinguisher was charged and last serviced on 04/30/2024; and first aid kit had Licensing requirements. Disaster drills are conducted quarterly, the last drill was conducted on 06/05/2024.

Kitchen: At approximately, 10:00 AM LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps observed to be locked in a kitchen cabinet.

Medications: At approximately, 10:15 AM LPA observed medications are centrally stored and locked in the dinning room cabinet. No discrepancies observed.

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 113.5 degrees Fahrenheit.

Common Areas: These included the living room and dining area. The common areas appeared clean and were properly furnished. LPA measured the room temperature to be 72 degrees Fahrenheit.
Continue on LIC809-C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2024
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: JL RESIDENTIAL CARE
FACILITY NUMBER: 197607838
VISIT DATE: 11/18/2024
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Smoke detectors/carbon monoxide. At 10:30 AM, LPA tested the dual functioning smoke and carbon monoxide detector to be operational.

Outside areas: At approximately, 10:40 AM LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. LPA did not observe any tripping hazard. A laundry area outside had a functioning washer and dryer. Detergents and other cleaning supplies were locked in the cabinets outside. The back yard was maintained and had gardened areas with fruit trees. The facility has a swimming pool and LPA observed to be locked and inaccessible to clients. Exit doors were unlocked, and all emergency exit paths were free from obstructions.



Between 11:30 AM to 12:30 AM, LPA reviewed records of four (4) clients and two (2) staff. Client and staff records appeared to be complete and updated.

Administrative: LPA collected Certificate of Liability Insurance, and LIC500.

No deficiency cited during today’s visit.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
LIC809 (FAS) - (06/04)
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