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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609499
Report Date: 09/18/2023
Date Signed: 09/18/2023 04:04:53 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/18/2023 04:04 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.ASC, 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:
09/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Medina LeyesTIME COMPLETED:
04:05 PM
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At 1:40 a.m. on 09/18/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and disclosed the reason for the visit. LPA and staff toured the facility inside and out at 2:30 p.m. today. No immediate health and safety risks were observed.

The facility was last visited on 08/11/2022 for an annual visit. It is a single story building with 4 bedrooms, 2 bathrooms, kitchen. garage, common areas, and outdoor areas. It has an approved fire clearance for 3 ambulatory clients and 1 non-ambulatory client. A file review was completed prior to the visit.

Entry: The yard at the main entrance was well maintained. Once inside, LPA observed hand sanitizer, masks, and required postings.

Bedrooms: The facility had 4 bedrooms. bedrooms served as client bedrooms, and one bedroom was used as a staff room. The staff room was free of hazards. All bedrooms contained a chair, lamp, nightstand, storage, and a bed with adequate bedding. All furnishings were clean and in good condition.

Bathrooms: The facility had 2 bathrooms. Bathrooms contained liquid soap, paper towels, a trash can with a tight fitting lid, grab bars, and a non-skid mat. At approximately 2:45 p.m. LPA measured the water temperature to be 111.6 degrees Fahrenheit.

Common areas: Walls, floors, windows, screens, and blinds were clean and in good repair. At 3:00 p.m. LPA measured the room temperature to be 76 degrees Fahrenheit. LPA observed a functioning house phone in the living room. A fire place was turned off and appropriately covered.

Kitchen: LPA observed an adequate supply of perishable and non-perishable foods. The stove hood was clean. Appliances were in good condition. Sharps and medications were locked below the counter top.

Laundry: A washing machine and dryer were located near the kitchen. Both were in working order. Detergents and cleaning solutions were locked below the kitchen counter top.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE: DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: PRIME CHOICE HOME CENTER
FACILITY NUMBER: 197609499
VISIT DATE: 09/18/2023
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Outdoor areas: LPA observed a covered patio area in the rear of the facility. The patio contained furniture in good condition.

Safety: The two emergency exit paths on the sides of the facility were free from obstructions. At approximately 2:50 p.m., the dual-functioning smoke and carbon monoxide detector was tested and operational. At approximately 3:15 p.m. LPA observed a fully charged fire extinguisher near the kitchen. It was last inspected on 08/04/2023.

Garage: The garage was locked and inaccessible and contained extra supplies.

At 3:30 p.m. LPA reviewed staff and resident files.

During today's inspection, the facility was in compliance with Title 22 regulations.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
LIC809 (FAS) - (06/04)
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