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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607967
Report Date: 07/28/2024
Date Signed: 07/28/2024 03:39:22 PM

Document Has Been Signed on 07/28/2024 03:39 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:LANNY'S HOMEFACILITY NUMBER:
197607967
ADMINISTRATOR/
DIRECTOR:		LANNY WONOPRABOWOFACILITY TYPE:
735
ADDRESS:10445 ARNWOOD RDTELEPHONE:
(818) 899-7374
CITY:LAKEVIEW TERRACESTATE: CAZIP CODE:
91342
CAPACITY: 4CENSUS: 4DATE:
07/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:16 PM
MET WITH:Richard Denogean - Assistant AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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A Required One (1) year visit was conducted today by Licensing Program Analyst (LPA) Gary Tan. LPA met with Assistant Administrator Richard Denogean. Purpose of visit was stated. LPA observed that all four (4) residents were at the facility during visit. This facility is North Los Angeles Regional Center vendored facility Level IV-G (Medical).

A tour of the physical plant was conducted at 12:24 PM and the following was noted:

The only entrance being utilized is the main front door. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Mitigation and Infection Control Plan.

Signs to wear a mask and other Covid 19 prevention protocol signs were posted outside the doors. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. All trash cans were observed to be with cover.

The facility has a designated visitors' area at the backyard by the pool. The facility has sufficient stock of PPE in the storage room.

Facility has four (4) bedrooms and two (2) bathrooms and one (1) toilet. Two (2) bedrooms are designated for staff use and one (1) bathroom and one (1) toilet is designated for staff use. There is an office adjacent to the living room. The facility is fire cleared for four (4) non-ambulatory residents.

Bedrooms were toured and observed to be clean and properly furnished. Linen storage was also checked and observed to have ample supply of clean linen and towels.
Bathrooms were observed to be clean and sanitary with necessary supplies. Hot water temperature measured at 115.1°F and within the required range. (continued to LIC 809-C)
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2024
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: LANNY'S HOME
FACILITY NUMBER: 197607967
VISIT DATE: 07/28/2024
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(continued from LIC 809)

Physical plant was checked for cleanliness and condition. Facility was in good repair and observed to be clean and free of clutter during today's visit.
Living and dining room furniture were also checked for functionality (wear and tear). Furniture was observed to be in good condition.
Kitchen area was observed to be clean and sanitary. All the toxins, cleaning solutions and disinfectants are locked in the garage.
Food. The facility is observed to have sufficient food supply for the clients both perishable and non-perishable.
Temperature of facility wall thermostat was set at 74°F and observed to be within the required range.
Fire extinguisher. There are two (2) fire extinguisher in the facility: one (1) in the kitchen, one (1) in the hallway of the bedrooms. Extinguishers were observed to be operable and last checked on 03/24/24 Smoke alarms are hardwired and interconnected. Carbon monoxide and smoke alarms were tested and observed to be operable. The Garage is currently being used as a storage for used equipment, frozen food, PPEs, hygiene and other supplies. The Backyard has shaded area in the swimming pool area. Swimming pool is appropriately fenced and was observed to be locked. Laundry area is located in the garage. Laundry detergents and other cleaning agents and toxins are kept locked in the cabinet in the laundry area. Knives and sharps were kept in a locked kitchen drawer. Medication was observed to be inaccessible and stored in a secured medication cabinet in the kitchen. There is a complete First Aid kit in the medication cabinet. Staff and clients records are reviewed and appeared to be complete and updated.

Disaster drill was last conducted on 07/10/24. Required posting observed in facility (complaint hot line poster, personal rights, etc).

There was no immediate health and safety hazard observed during the day of inspection. Exit interview conducted and a copy of this report was given.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2024
LIC809 (FAS) - (06/04)
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