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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609499
Report Date: 03/04/2024
Date Signed: 03/04/2024 01:11:10 PM

Document Has Been Signed on 03/04/2024 01:11 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:PRIME CHOICE HOME CENTERFACILITY NUMBER:
197609499
ADMINISTRATOR:DENZARMONE REEDFACILITY TYPE:
735
ADDRESS:20616 KITTRIDGE STREETTELEPHONE:
(818) 392-8833
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY: 4CENSUS: 3DATE:
03/04/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Armando OliverosTIME COMPLETED:
01:30 PM
NARRATIVE
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On 03/04/24 LPA Casillas arrived at facility above to conduct an initial 10-day complaint investigation for complaint # 31-AS-20240228154113. This Case Management is not related to the original complaint visit. During the facility tour LPA observed that cleaning supplies were unlocked. Residents had access to cleaning supplies and were doing their own laundry without supervision.

During LPA’s tour, LPA observed that a hallway closet with a sign that read “REMINDER PLEASE ENSURE CABINET IS LOCKED AT ALL TIMES!!!! -ADMINISTRATOR”. However, the cabinet was not locked and a client #1 (C1) was able to take laundry soap out and begin doing laundry without supervision. Upon learning LPA’s identity C1’s one on one came out to introduce themselves. LPA asked staff #1 (S1) if that cabinet was supposed to be locked, they were not able to respond with a concrete yes or no.

LPA explained to House Manager the importance of locking the cabinet and House Manager immediately locked the cabinet. LPA was able to speak via telephone with Administrator and advised that a citation would be issued for this deficiency. LPA also advised Administrator and House Manager that there would need to be a training of all staff on the importance of keeping harmful items locked for client safety. Administrator will email LPA a copy of the training that was provided along with a log of all staff that was in attendance by end of POC date.

Please see LIC809-D

Exit Interview conducted. Citation Issued. Appeal rights discussed and provided to House Manager .

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2024
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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Document Has Been Signed on 03/04/2024 01:11 PM - It Cannot Be Edited


Created By: Lorena Casillas On 03/04/2024 at 12:52 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: PRIME CHOICE HOME CENTER
FACILITY NUMBER: 197609499

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/05/2024
Section Cited
CCR
80087(g)

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80087(g) Buildings and Grounds (g)Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement was not met as evidence by:
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Cabinet was locked in LPA’s presence. Administrator will email LPA a copy of the training that was provided along with a log of all staff that was in attendance by end of POC date.
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Based observation, staff do not ensure that cleaning supplies were locked and inaccessible to clients, this poses an immediate health and safety and personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Nichelle Gillyard
LICENSING EVALUATOR NAME:Lorena Casillas
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2024


LIC809 (FAS) - (06/04)
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