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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609482
Report Date: 01/27/2022
Date Signed: 01/27/2022 12:37:54 PM

Document Has Been Signed on 01/27/2022 12:37 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:PARAMOUNT SPECIAL HOME CARE CORPORATIONFACILITY NUMBER:
197609482
ADMINISTRATOR:QUIJANO, LOIDAFACILITY TYPE:
735
ADDRESS:7044 FALLBROOK AVETELEPHONE:
(747) 226-1864
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY: 4CENSUS: 4DATE:
01/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Glocidy VillaverdeTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced annual required visit.
LPA met with staff and explained the reason for this visit. Administrator was contacted and made aware of this visit.

LPA conducted a physical plant tour from 11:40-12:10pm. LPA observed smoke detector and carbon monoxide detector to be working properly.

Kitchen: The kitchen appeared clean and the appliances and fixtures functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. LPA found knives and sharp objects stored in a locked cabinet.

Bedrooms: There were three bedrooms designated for clients' use. All bedrooms were clean, properly furnished and had appropriate bedding and linens. There is a staff room which is kept locked while not in use.

Bathrooms: There were two bathrooms designated for clients' use. All bathrooms were clean, properly supplied and had functional fixtures. Hot water temperature was measured at 115 degrees Fahrenheit.

Common Areas: These included the living room and dining area. The common areas appeared clean and were properly furnished. Properly labeled medications were locked in a cabinet in the kitchen.
Surrounding Grounds: There was furniture appropriate for outdoor use and no visible hazards. All passageways were free of obstruction.
No deficiencies were cited during this visit. Exit Interview conducted.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Wendell Smith
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2022
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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