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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609036
Report Date: 01/13/2025
Date Signed: 01/15/2025 01:47:58 PM

Document Has Been Signed on 01/15/2025 01:47 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:EVENING GRACE ASSISTED LIVINGFACILITY NUMBER:
197609036
ADMINISTRATOR/
DIRECTOR:
KENEZ, PAULFACILITY TYPE:
740
ADDRESS:17452 TIARA STREETTELEPHONE:
(818) 654-6087
CITY:ENCINOSTATE: CAZIP CODE:
91316
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
01/13/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:20 PM
MET WITH:Diana Kenez- administratorTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analysts (LPA), Leslie Ngo-Castaneda conducted an unannounced Required 1-year inspection at this facility at approximately 3:20 PM LPA were greeted by staff, Coxia Carandang and was explained the reason for the visit. at 3:45 PM the administrator arrived and was disclosed the purpose of the visit.

LPA conducted a tour of the physical plant at approximately 3:38 PM to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

Common areas were observed for the ability to safely serve the needs residents. These included the kitchen, dining room area and living room. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to be furnished appropriately.

LPA reviewed the food service areas, food storage and supply (perishable and nonperishable foods). The
kitchen food supply was observed and sufficient for the six (6) residents currently residing there. Two (2) days of perishable food observed. The freezer is stocked with meats and frozen vegetables. Sharps are stored in locked kitchen drawer. The resident medications are locked in office cabinets near the kitchen. The medications were observed to be inaccessible to residents. There is one (1) fire extinguishes located in the kitchen. Fire extinguishers observed to be charged at 10.13.2024.

Laundry room beside the kitchen and has an attached garage. The appliances observed to be functional.

Due to time constraints this required annual will be completed at a later time.

Exit interview conducted/Copy of report given
Nichelle GillyardTELEPHONE: (818) 596-4370
Leslie Ngo-CastanedaTELEPHONE: (818) 214-9900
DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2025
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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