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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608406
Report Date: 06/12/2024
Date Signed: 06/12/2024 02:16:44 PM

Document Has Been Signed on 06/12/2024 02:16 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:E-SOLFACILITY NUMBER:
197608406
ADMINISTRATOR/
DIRECTOR:		MICHAEL STEPHENSFACILITY TYPE:
775
ADDRESS:7144 BALBOA AVENUETELEPHONE:
(818) 881-4427
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 49CENSUS: 44DATE:
06/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Haley RhyneTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analysts (LPAs) Valeria Conway and Brian Balisi arrived unannounced to conduct a required one-year annual inspection. The LPAs met with Program Director Haley Rhyne and explained the reason for the visit. At 10:05 a.m., the LPAs and Ms. Rhyne toured the physical plant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. At the time of the visit all participants were out in the community

Common Activity Space: LPAs observed surveillance cameras all trough out the common areas. The facility is a single-story structure with two multi-purpose rooms, two bathrooms, staff offices/lounge area, and a kitchen. The LPAs did not observe any obstructions or hazards. Equipment used for activities was in good condition at the time of the visit. At approximately 10:30 am, LPAs observed staff in training. The fire extinguishers were fully charged and were last serviced on 04/24/2024. Smoke detectors and carbon monoxide detectors were inspected on 03/12/2024, a devise was replaced after the inspection and facility is waiting of subsequent visit to re-test fire alarm devises. LPAs observed fire alarm devises to be operational. Program Director will provide copy of inspection test once is completed. No bodies of water noted. Fire drills are conducted monthly.

Food Service: The LPAs toured the kitchen/food service area, which was clean and in good condition. Cleaning supplies, chemicals, sharps, and knives are locked in a kitchen cabinet and inaccessible to participants. At 10:20 am hot water temperature was measured at 107 degrees Fahrenheit. The facility provides snacks to the consumers.

Continued LIC 809-C

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: E-SOL
FACILITY NUMBER: 197608406
VISIT DATE: 06/12/2024
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Continued from LIC 809

Restrooms: Restrooms were clean and had sufficient supplies of paper towels, soap and toilet paper. LPAs observed trash cans not to have lids to protect consumers from cross contamination. Between 10:32 and 10:37 am, hot water temperature was tested and measured at 105 degrees Fahrenheit in the women restroom and 106.1 degrees Fahrenheit in the men restroom.

Participant records: At 11:20 a.m., the LPAs reviewed nine (9) participant files and checked for annual service plans/IPPs, admission agreements, and medical assessments. All nine (9) staff files observed were in compliance with regulation.

Staff records: File review began at 12:07 p.m. The LPAs reviewed six (6) staff files and checked for valid first aid/CPR, medical assessments, the appropriate training, and personnel records. Training hours were verified. All six (6) staff files observed were in compliance with regulation.


Medications: The facility currently does not have consumers that require assistance with the self-administration of medication.

Interviews: From 12:50 p.m. – 1:05 p.m., the LPAs interviewed three staff, no immediate health or safety concerns noted. LPAs were not able to interview participants because usually they arrive around 2 p.m.

Exit interview conducted. Report issued and provided to Program Director.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC809 (FAS) - (06/04)
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