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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608977
Report Date: 05/21/2022
Date Signed: 05/21/2022 02:42:05 PM

Document Has Been Signed on 05/21/2022 02:42 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:THOMPSON'S GUEST HOMEFACILITY NUMBER:
197608977
ADMINISTRATOR:SAVELLA, JEFFREYFACILITY TYPE:
740
ADDRESS:22835 STRATHERN STTELEPHONE:
(818) 348-0995
CITY:WEST HILLSSTATE: CAZIP CODE:
91304
CAPACITY: 6CENSUS: 6DATE:
05/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Mary Lynn SaideTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced annual visit. LPA met with facility staff and explained the reason for this visit. LPA spoke with administrator Jeffrey Savella by telephone and explained the reason for this visit.
A tour of the physical plant was conducted from 1:15-1:45pm. The facility consists of a single-story residence with four (4) client bedrooms and two (2) client bathrooms. There is a staff room. All exit signal alarms were tested and function properly. Smoke detectors and Carbon Monoxide detector were tested and functioned properly during time of visit. Fire extinguishers were observed to be fully charged and tested. All indoor and outdoor passageways/ exits were free of obstruction.
Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient supply of perishable and non-perishable food to be properly stored at the facility. Knives, cleaning agents, and other potentially hazardous items were locked and inaccessible. Bedrooms: The resident bedrooms were properly furnished with at least one chair, night stand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Bathrooms: LPA observed all bathrooms to be clean, properly supplied and equipped with functional fixtures. LPA observed grab bars and non-skid mats in all bathrooms. Residents have sufficient amounts of supplies for personal hygiene. Hot water measured within the required limit of 105-120 degrees Fahrenheit in all bathrooms/ sinks during visit. Common Areas: Facility common areas such as living room and dining room appeared to be clean and appropriately furnished at the time of this visit, no accessible hazards were observed. Surrounding Grounds: There was a shaded area with appropriate furniture for outdoor use. There are also several storage sheds and a separate structure used as a storage area and staff office.
LPA observed staff to be following infection control protocols. LPA's temperature was checked upon entry and sign in sheet was signed. LPA observed hand sanitizer station in the facility and proper signs were posted.
No deficiencies cited during visit. Exit interview conducted.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2022
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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