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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607967
Report Date: 06/14/2022
Date Signed: 06/14/2022 02:05:38 PM

Document Has Been Signed on 06/14/2022 02:05 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:LANNY'S HOMEFACILITY NUMBER:
197607967
ADMINISTRATOR:LANNY WONOPRABOWOFACILITY TYPE:
735
ADDRESS:10445 ARNWOOD RDTELEPHONE:
(818) 899-7374
CITY:LAKEVIEW TERRACESTATE: CAZIP CODE:
91342
CAPACITY: 4CENSUS: 4DATE:
06/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Fnu Midiyahti & Ester CordovaTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted an mitigation inspection visit. LPA was greeted by caregivers who was informed the reason of the visit. Caregivers contacted Administrator, who was at a funeral and was not able to come to the facility. The Administrator contacted her brother-in-law, Richard Denogean, who LPA spoke briefly over the phone. LPA was informed, staff would be able to answer questions pertaining to the visit.
Upon entering, LPA's temperature was taken, and a visitors book was available. LPA observed staff to have full mask covering; a hand sanitizing station; PPE supplies at the front door; COVID-19 and Licensing postings were observed on the walls throughout the facility.

The facility currently has (4) clients. All clients and staff are vaccinated, and a few days ago, received there (2nd) booster shot. The facility has been COVID free since the pandemic. Clients temperatures are checked twice daily, in the morning and evening. LPA inspected rooms, and client's bed are (6) feet apart. The facility practices social distancing and clients don't eat together; (3) clients are on liquid diets.

There are designated rooms for potential positive COVID clients. PPE, chemicals, cleaning supplies, and paper products are available.

Exit interview and copy of report provided via email.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2022
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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