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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608752
Report Date: 12/12/2024
Date Signed: 12/12/2024 04:15:12 PM

Document Has Been Signed on 12/12/2024 04:15 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:SENIOR CARE AT NORTHRIDGE INC.FACILITY NUMBER:
197608752
ADMINISTRATOR/
DIRECTOR:
JAIME MONTEROFACILITY TYPE:
740
ADDRESS:19241 CALAHAN STREETTELEPHONE:
(818) 727-0338
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
12/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Jaime MonteroTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with Administrator Jaime Montero and explained the reason for the visit. At approximately 09:30 a.m., with the administrator's assistance, LPA took a tour of the physical plant, and the following were observed.

Required postings were observed in the entry area. The smoke alarms are hardwired and function properly. Carbon monoxide detector functions properly and is located in the hallway in between residents' rooms. The fire extinguisher is located in the kitchen. The charge date is October 14, 2024.


Bedrooms: There were six (6) bedrooms designated for residents' use. All bedrooms were clean, properly furnished, and had sufficient lighting. All six (6) bedrooms are designated for private use. Bathrooms: There were three (3) bathrooms in the facility. One (1) bathroom in the hallway which is the main and one (1) bathroom in the private bedroom and one (1) designated for staff use. All bathrooms were clean, properly supplied, and had functional fixtures. Hot water temperature was measured from the bathroom sink at 108.7 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets. Temperature: Facility maintains a comfortable temperature of 77 degrees Fahrenheit. Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. The dining room table is large enough to sit the capacity of the facility. Seating such as couches were in good repair and sat the capacity of the facility. There is a fireplace properly secured with a screen. Common areas observed furnished appropriately. Surrounding Grounds: Entry/exits were free of obstruction. The outdoor area was free of hazards. No body of water was observed. The laundry area is located in the garage, which is inaccessible to residents. All toxins are locked. Resident Files LPA conducted a file review of resident records to ensure compliance with licensing forms. Staff Files: LPA also conducted a file review of staff records to ensure forms and training are up to date and compliant with licensing forms.Medications: Medication and Medication Records were reviewed for proper documentation. Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies were observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.
Eva MillerTELEPHONE: (818) 596-4373
Mariana AgbanTELEPHONE: 818-738-4525
DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2024
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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