197609516-9-29-2023-31-AS-APAA-CW5Q34-20230929114808

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609516
Report Date: 09/29/2023
Date Signed: 09/29/2023 11:48:45 AM

Document Has Been Signed on 09/29/2023 11:48 AM - 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 FACILITY		FACILITY NUMBER:	197609516
ADMINISTRATOR:	OLANO, CHRISTIAN		FACILITY TYPE:	735
ADDRESS:	10613 HILLVIEW AVENUE		TELEPHONE:	(818) 310-5070
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY: 4		CENSUS: 4	DATE:	09/29/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Christian Olano, Administrator		TIME COMPLETED:	12:10 PM

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At 9:20am Licensing Program Analysts (LPAs), Angela Panushkina, Leslie Ngo-Castaneda and Huma Rahimi conducted an unannounced annual inspection at the facility mentioned above. LPAs were greeted by the Staff, Nadia Aviles, who granted access to the facility. Administrator arrived shortly after and LPAs explained the reason for the visit. Physical tour was conducted with the Administrator and LPAs observed the following:

Kitchen: At approximately, 9:30am LPAs toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps observed to be locked in a drawer and inaccessible to clients in care. Fire extinguisher in the kitchen was purchased on 09/29/2023.

Medications: At approximately, 9:35am LPAs observed medications are centrally stored and locked in the kitchen cabinet.

Bedrooms: There are three (3) bedrooms designated for clients use with sufficient lighting. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Staff bedroom was observed to be locked and inaccessible to clients in care.

Bathrooms: At 9:50am LPAs observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPAs observed appropriate grab bar and client's bathroom had non-skid mat. LPAs observed appropriate hand washing signs posted in each bathroom. All trash cans in bathrooms had fitted lids to protect from cross contamination. Hot water temperature measured at 120°F.

Common Areas: The facility maintains a comfortable temperature at 69°F. The living room and dining area

Continue on LIC809-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

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: 09/29/2023

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appeared clean and were properly furnished. The living room has a television, comfortable furniture and the fireplace is adequately screened. No obstructions and or tripping hazards throughout the facility. Laundry is located in the attached garage that can be accessed through the staff's bedroom. LPAs observed all detergents locked and inaccessible to clients in care. Extra PPE supplies and food storage was also observed.

Smoke detectors/carbon monoxide. Smoke detectors were located throughout the facility, and at 10:20am they were tested and observed to be operational. Carbon monoxide was located in a hallway and was also tested and observed to be operational.

Outside areas: At approximately, 10:30am LPAs toured the outside area of the facility. LPAs observed appropriate outdoor furniture, with a covered shaded area for clients.There is a swimming pool that is fenced all around with a gate. The fence surrounding the swimming pool is approximately 5 feet high all around. You will need a key to gain entry to the swimming pool as it is kept locked at all times. LPAs discussed the importance of maintaining the care and supervision to meet the needs of clients.

Between 10:50am to 11:30am, LPAs reviewed records of four (4) clients and two (2) staff. Client and staff records appeared to be complete and updated.

Administrative: LPAs collected Certificate of Liability Insurance, and LIC.500.

No citations issued during this visit. Exit interview conducted. Copy of report emailed to the Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

LIC809 (FAS) - (06/04)

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