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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609495
Report Date: 11/04/2021
Date Signed: 11/05/2021 07:56:35 AM

COMPREHENSIVE INSPECTION
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:WOODLAKE LOVING CARE LLCFACILITY NUMBER:
197609495
ADMINISTRATOR:ARDAKANI, SHAKILAFACILITY TYPE:
740
ADDRESS:8016 WOODLAKE AVETELEPHONE:
(818) 217-6778
CITY:WEST HILLSSTATE: CAZIP CODE:
91304
CAPACITY:6CENSUS: 3DATE:
11/04/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Shakila Ardakani TIME COMPLETED:
03:25 PM
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At 2:30pm Licensing Program Analysts (LPA) Eleza Jackson conducted an unannounced annual inspection. Mitigation plan was reviewed. A physical tour was conducted at 2:45pm and the following was observed: Infection control: Upon arrival, Caretaker/Aysha Rashha took LPA Jackson’s temperature and instructed LPA to sign-in the visitors’ log. Proper signage was observed inside of the facility. Administrator stated that the facility has sufficient PPE supplies for residents and staff.Food Inspection: LPA Jackson observed a sufficient supply of perishable and non-perishable foods. Food storage and preparation appear to be clean and inaccessible to pests. Smoke detectors/carbon monoxide were deemed to be in operating condition. Fire extinguisher is up to code.Resident rooms: All residents bedrooms were properly furnished with appropriate bedding, sufficient lighting, and the rooms appeared to be clean.Bathrooms: LPA Jackson observed appropriate hand washing signs posted in the bathroom, grab bars and non-skid mat. Medications are centrally stored and locked.Outside areas: LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for clients.

No deficiencies issued.



Exit interview conducted.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Eleza JacksonTELEPHONE: (661) 361-6007
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
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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