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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608309
Report Date: 06/20/2024
Date Signed: 06/20/2024 05:11:18 PM

Document Has Been Signed on 06/20/2024 05:11 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:ETTA ISRAEL CENTER #4FACILITY NUMBER:
197608309
ADMINISTRATOR/
DIRECTOR:
HEIDI SCHOFIELDFACILITY TYPE:
735
ADDRESS:6101 BLUEBELLTELEPHONE:
(818) 980-1709
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91606
CAPACITY: 6CENSUS: 6DATE:
06/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:14 AM
MET WITH:Heidi Schofield, AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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Licensing Program Analyst(LPA) Christine Yee conducted and unannounced required Annual Inspection using the complete CARE Inspection Tool and met with Heidi Scholfield, Administrator. Also participating in today's visit was Giovanna Montano, House Manager. The reason for today's visit was provided.

The home is a single storey family home consisting of a front room, living room, dining room, kitchen, 4 bedrooms, 1 common bathroom, a private bathroom and a detached garage. The home is fire cleared for 6 ambulatory clients only and is vendorized by the North Los Angeles County Regional Center.

All 12 domains of the Care Inspection Tool was reviewed during today's inspection and a tour of the home, inside and outside, was conducted. The following were observed:
  • The living room, dining room and kitchen and front room were furnished and equipped with the appropriate furniture and equipment.
  • All four resident bedrooms were furnished with the required furniture and had appropriate lighting. The front corner room and back bedroom are shared rooms.
  • All resident beds had the required bed linens and extra linens were observed in the linen closet and resident closets.
  • The common bathroom contains a shower, 2 sinks and a toilet. Grab bars were observed. Water temperature was tested and read 119.4 degrees Fahrenheit. The private bathroom located in the back bedroom has a shower stall, 2 sink vanity and a toilet. Grab bars and a non-skid mat was observed. Water temperature was tested and read 119.3 degrees Fahrenheit.
  • Perishable and non-perishable foods were reviewed and met Title 22 requirements since today was the facility's food delivery day. The Administrator was advised that perishable food for a minimum of 2 days and non-perishable foods for a minimum of 7 days must be maintained on the premises.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ETTA ISRAEL CENTER #4
FACILITY NUMBER: 197608309
VISIT DATE: 06/20/2024
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  • Facility also maintains dehydrated emergency food supply. Bottles of drinking water were observed in the kitchen and in the garage
  • Medications were centrally locked in a cabinet located in the dining room.
  • Cleaning solutions and laundry detergents are stored in a locked closet by the front door.
  • The interconnected smoke detectors were tested and were operational. The smoke detector located in the resident hallway is a combination smoke/carbon monoxide detector.
  • The single carbon monoxide detector located in the living room was tested and was operational.
  • The facility has 2 fire extinguishers. One is located in the laundry room and the second one is located in the front room. Both fire extinguishers were last serviced on 10/18/23.
  • A table with chairs and an umbrella for shade were observed in the backyard.
  • The outside areas, back and front , were observed to be clean and well maintained.
  • Trash cans along the left side of the home were observed to be tightly sealed.


No deficiencies were cited on today's visit.

Exit interview was conducted.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024
LIC809 (FAS) - (06/04)
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