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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609024
Report Date: 04/02/2024
Date Signed: 04/02/2024 01:12:24 PM

Document Has Been Signed on 04/02/2024 01:12 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 S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:CENTROFACILITY NUMBER:
197609024
ADMINISTRATOR:JUANA I. BUSBYFACILITY TYPE:
735
ADDRESS:2315 N SANTA ANITA AVETELEPHONE:
(626) 529-5940
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY: 6CENSUS: 6DATE:
04/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Juana Ivett Busby, AdministratorTIME COMPLETED:
01:45 PM
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At 9:45 AM Licensing Program Analyst (LPA), Huma Rahimi, conducted an unannounced annual inspection at the facility mentioned above. LPA met with staff Sally Ibarra, and the Administrator was contacted over the phone and LPA discussed the purpose of this visit. Administrator arrived at the facility later. Physical tour was conducted with the staff and LPA observed the following:

Kitchen: At approximately, 10:10 AM LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps observed to be locked in a standing cabinet in the kitchen. LPA observed a working washer and dryer installed in the kitchen and laundry detergents, cleaning agents and other toxins locked in a cabinet next to dryer and washer in the kitchen. The fire extinguisher was located in the kitchen and was last purchased on 12/02/2023.

Medications: At approximately, 10:15 AM LPA observed medications area centrally stored and locked in a separate standing cabinet in the kitchen.

Bedrooms: The facility is fire cleared for six (6) ambulatory clients. LPA observed total of three (3) bedrooms designated for clients use. Bedrooms are shared. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Facility has an awake staff.

Bathrooms: LPA observed two (2) bathrooms and both appeared to be clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and client's bathroom had non-skid mat. LPA observed appropriate hand washing signs posted in each bathroom. Hot water temperature measured at 120°F.



Continue on LIC809-C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE: DATE: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CENTRO
FACILITY NUMBER: 197609024
VISIT DATE: 04/02/2024
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Common Areas: The facility maintains a comfortable temperature at 69°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility. There is a fireplace in the living room that was not in use and covered with fireplace screen. LPA observed the large dining table with 6 chairs and a bookshelves stocked with the books, games, and puzzles. The garage is currently being used for storage and has an extra fridge for extra food.
Smoke detectors/carbon monoxide. Smoke detectors were located throughout the facility, and at 10:28 AM they were tested and observed to be operational. Carbon monoxide was located in the kitchen and was also tested and observed to be operational.

Outside areas: At approximately, 10:40 AM LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. LPA observed two exits and both were free of obstruction and hazards. The facility does not have a swimming pool or any bodies of water.



Between 10:45 AM to 12:00 PM, LPA reviewed records of four (6) clients and four (4) staff. Client and staff records appeared to be complete and updated.

Administrative: LPA collected Certificate of Liability Insurance, and LIC500.

No deficiency cited during today’s visit.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024
LIC809 (FAS) - (06/04)
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