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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608927
Report Date: 10/19/2022
Date Signed: 10/20/2022 11:04:17 AM


Document Has Been Signed on 10/20/2022 11:04 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:JUST LIKE HOME IIFACILITY NUMBER:
197608927
ADMINISTRATOR:MARAT DAVIDIANFACILITY TYPE:
740
ADDRESS:13524 CHANDLER BLVD.TELEPHONE:
(818) 769-9955
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91423
CAPACITY:6CENSUS: 6DATE:
10/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:16 AM
MET WITH:Marat DavidianTIME COMPLETED:
12:21 PM
NARRATIVE
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On 10/18/2022, Licensing Program Analyst (LPA) Sandra Urena, arrived at the facility unannounced to conduct a required annual inspection. This visit had an emphasis on infection control. LPA Urena arrived at the facility at 10:26 a.m., and met with administrator Marat Davidian. The purpose of the inspection was discussed with the administrator.

Infection Control: Upon entry, the facility has a sign in book, and sanitizing gel. Infection Control signage was visible at entrance. Temperature was taken by caregiver, before allowing LPA Urena enter the premises. Temperature was recorded in sign in sheet.

From 10:36 a.m. to 11:14 a.m., LPA Urena, and the administrator conducted a tour of the inside, and outside of the facility to ensure there are no health and safety hazards, and the facility is in compliance with Title 22 Regulations.

Common Areas: LPA Urena, and administrator toured the common areas (living room and dining room). The walls and flooring were checked for cleanliness and were observed to be in good condition. Furniture was observed to be clean, appropriate, and in good condition. Room temperature was recorded at 75 degrees Fahrenheit.

Kitchen: At 10:55 a.m., it was observed by the LPA, and administrator that the knives were stored in an unlocked kitchen drawer. At 10:58 a.m., chemicals were observed to be unlocked under the sink cabinet. Kitchen appliances were in operable condition. The facility has enough supply of perishable and non-perishable food. Freezer and refrigerator are stocked with a variety of foods. Fire extinguisher was observed to be serviced within the last year. The administrator was advised to mount the fire extinguisher for easy, and safe access in case of a fire emergency.

Continues on LIC 809C...

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2022
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 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: JUST LIKE HOME II
FACILITY NUMBER: 197608927
VISIT DATE: 10/19/2022
NARRATIVE
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Bedrooms: The facility has six bedrooms with single occupancy, each bedroom has a private bathroom. Bedrooms were furnished appropriately with appropriate furnishings, bed linens, and sufficient lighting.

Bathrooms: Each of the six (6) bathrooms were observed to be clean; shower area was in clean condition with grab bars and a non-skid mat available. Paper towels were available for drying hands. Hand washing sign was displayed, and sufficient amounts of soap, and paper products in each restroom. The facility has a staff/visitor bathroom in the hallway.

Hallway: Medications were observed to be locked away in the closet area, and were inaccessible from residents.

Outdoor Space: Backyard has a shaded outdoor area equipped with outdoor furniture in good repair for residents’ use. There were no bodies of water noted. Passageways were free of obstruction.



Pantry: An adequate supply of emergency food for six residents and two staff was available.

Garage Area: Diapers, and Personal Protection Equipment (PPE) is adequate, and the facility is able to obtain additional supplies as needed.

The facility’s cleaning protocol is sufficient. The facility’s policies and procedures as it pertains to infection control are adequate.

Citations were issued at this time. Exit interview was conducted, a copy of the report and Appeal Rights were issued.

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 10/20/2022 11:04 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364


FACILITY NAME: JUST LIKE HOME II
FACILITY NUMBER: 197608927

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/24/2022
Section Cited

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87309(a) Knives, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
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Based on observation, the licensee did not comply with the section cited above as knives were accessible in an unlocked kitchen drawer, which poses an immediate health and safety risk to residents in care.
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Type A
10/24/2022
Section Cited

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87309(a)Disinfectants, cleaning solutions, knives, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
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Based on observation, the licensee did not comply with the section cited above as disinfectants and cleaning solutions were accessible in an unlocked kitchen cabinet, which poses an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2022
LIC809 (FAS) - (06/04)
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