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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609516
Report Date: 09/22/2022
Date Signed: 09/22/2022 01:30:29 PM

Document Has Been Signed on 09/22/2022 01:30 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:ESPERANZA FACILITYFACILITY NUMBER:
197609516
ADMINISTRATOR:OLANO, CHRISTIANFACILITY TYPE:
735
ADDRESS:10613 HILLVIEW AVENUETELEPHONE:
(818) 310-5070
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY: 4CENSUS: 4DATE:
09/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 AM
MET WITH:Christian Olano TIME COMPLETED:
01:40 AM
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On 09/22/22 at 12:00 p.m Licensing Program Analyst (LPA) Joscelyn Martinez arrived at the facility to conducted an unannounced annual inspection. Upon arrival LPA was greeted by staff and LPA’s temperature was taken. LPA Martinez later met with Administrator Christian Olano and the purpose of the visit was explained. A physical tour of the facility was conducted and the following was observed:

Infection Control: Covid-19 infection control signage were observed outside of the facility. Proper signage was also observed inside in the common areas. Facility has sufficient PPE supplies for more than 30 days. Food Inspection: LPA observed there to be sufficient stock of one-week non-perishable foods and two-day perishable foods. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers in the kitchen. Chemicals are locked under the kitchen sink. Medications are centrally stored in a locked cabinet. Sharps are kept locked in a designated room. Smoke detectors/carbon monoxide are located throughout the facility and are hardwired. Smoke detectors and carbon monoxide detectors were tested at approximately 12:30 p.m. and appear to be functional. Fire extinguisher was observed to be charged and service within the year. Common Areas: All common areas were observed to be clean and properly furnished. Facility maintains a comfortable temperature of 74.0 F. Facility has two living area where one is designated for an activity room. Clients Rooms: Facility has four (4) bedrooms which of three (3) are designated for client use. Facility has one live-in staff. All four (4) bedrooms were toured and appear to be clean and properly furnished. LPA observed additional bedding and linens sufficient for all of the clients. All rooms have adequate lighting. Bathrooms: There are three (3) bathrooms in the facility of which two (2) are designated for client's use. LPA observed all bathrooms to be clean and free of any hazards. The hot water was tested in both client’s bathroom and measured at 116 F which is in regulation. All trash cans located in the bathrooms had tight fitting lids.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Joscelyn Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ESPERANZA FACILITY
FACILITY NUMBER: 197609516
VISIT DATE: 09/22/2022
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Garage: There is an attached garage that is being used for laundry area and additional storage. Garage is accessible through staff room. This area is inaccessible to clients. Outside Area: LPA observed appropriate outdoor furniture, with a covered shaded area for clients. There is a body of water that is gated and locked making it inaccessible to clients.

No deficiency cited. Exit interview conducted. Report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Joscelyn Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
LIC809 (FAS) - (06/04)
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