197607946-3-15-2022-31-AS-NRED-CCK373-20220315175916

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607946
Report Date: 03/15/2022
Date Signed: 03/15/2022 06:01:11 PM

Document Has Been Signed on 03/15/2022 06:01 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:	GLOBAL HCM CORPORATION		FACILITY NUMBER:	197607946
ADMINISTRATOR:	MERCEDE SHAMLO		FACILITY TYPE:	735
ADDRESS:	19514 HAYNES STREET		TELEPHONE:	(818) 578-3093
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY: 4		CENSUS: 3	DATE:	03/15/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:05 PM
MET WITH:	Mercecde Shamlo		TIME COMPLETED:	06:06 PM

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At approximately 3:05 PM on 03/15/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual visit. LPA met with staff and later Administrator and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out.

The facility is a single-story building with 4 bedrooms, 2 bathrooms, a kitchen, laundry area, family room, living room, garage, and back yard.

The facility employs a screening routine for all staff and visitors which includes hand sanitization, providing a new N95 mask, shoe sanitization, hand washing, temperature screening, and symptom check. The facility stores house shoes at the front for staff to use in the facility.

Upon entry, LPA observed a well maintained front yard with a ramp leading to the front door. The ramp had secure hand rails. The facility uses surveillance cameras at the front.

The screening station at the front included a digital thermometer, hand sanitizer, surgical masks, and N95 masks.

Bedrooms: The facility has 4 private bedrooms, of which 3 were occupied. All bedrooms contained a chair, nightstand, lamp, dresser, storage, and a bed with adequate bedding. LPA observed two locked cabinets by Bedroom #1 with consumer binders, medication, and extra medical supplies.

Bathrooms: The facility contained 2 bathrooms. All bathrooms contained fully stocked liquid soap, paper towels, trash cans with tight fitting lids, handwashing instruction signs, grab bars around the toilets and showers, and non-skid mats.

Safety: The facility had emergency exit plans located at the front and in every bedroom. Exit routes and reference points were labeled clearly. A fully charged fire extinguisher hung in the kitchen.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022

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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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: GLOBAL HCM CORPORATION	FACILITY NUMBER: 197607946
	VISIT DATE: 03/15/2022

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Kitchen: LPA observed an adequate supply of perishable and nonperishable food in the kitchen and in a refrigerator in the garage. LPA also observed a weekly menu and documentation of substitutions. On the side of the refrigerator hung the facility’s grievance procedure, house rules, consumer rights, and emergency contacts.

Laundry – Adjacent to the kitchen was a laundry area with an operable washer and dryer.

Common Areas – In the family room and living room, LPA observed games, puzzles, instruments, a television, and books. Seating was arranged to accommodate physical distancing.

Garage – Administrator and LPA toured a locked garage which contained extra food, water, paper supplies, cleaning solutions, and tools. An exit door was locked as well.

Outdoor space – LPA observed a covered patio area with chairs and a table, a shaded bench swing, a fenced water heater, and a locked office area which contained resident medications, files, and extra PPE.

All furniture, window screens, floors, ceilings, and walls were clean and in good repair.

LPA observed a symptom screening log for residents and for staff. Administrator showed LPA vaccination cards and training records for all staff.

During today's visit, facility is in compliance with Title 22 Regulations, no citations are issued.

Exit interview conducted and copy of the report issued.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2022

LIC809 (FAS) - (06/04)

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