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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608839
Report Date: 11/29/2023
Date Signed: 11/29/2023 04:02:36 PM


Document Has Been Signed on 11/29/2023 04:02 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:PRECIOUS SOMEONE HOMECARE INCFACILITY NUMBER:
197608839
ADMINISTRATOR:MADONNA OLILAFACILITY TYPE:
740
ADDRESS:7808 FALLBROOK AVENUETELEPHONE:
(818) 703-1271
CITY:WEST HILLSSTATE: CAZIP CODE:
91304
CAPACITY:6CENSUS: 4DATE:
11/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Mario Resurreccion- CaregiverTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with staff, Mario Resurreccion and explained the reason for the visit. Administrator Madonna Olila has joined shortly after.

At approximately 11:20 am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are interconnected and battery operated. There is a carbon monoxide detector that functions properly installed in the hallway between resident rooms. The fire extinguisher is located in the kitchen. The purchase date is November 29, 2023.

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.

Common Areas: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit.


Bedrooms: There were four (4) bedrooms designated for residents' use. Three(3) out 4 bedrooms are properly furnished with appropriate beddings and linens with sufficient lighting. LPA observed Room 1 is cluttered and there are many boxes stacked which creates difficulties opening the door room. LPA observed that Resident #1(R1) smokes in the room and thus the facility walls are yellow including the room curtains.
Surrounding Grounds: The outdoor area was cluttered with recycle bags, unused broken bed, table, and water dispenser.

LPA is unable to continue with the annual inspection. Additional visit be conducted. Deficiencies observed and will be cited during the subsequent visit.

SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana AgbanTELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2023
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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