197609568-1-19-2022-31-AS-NRED-CATU66-20220119141750

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609568
Report Date: 01/19/2022
Date Signed: 01/19/2022 02:18:33 PM

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:	BEWISE HOME		FACILITY NUMBER:	197609568
ADMINISTRATOR:	OKONKWO, CHINWEIKE		FACILITY TYPE:	740
ADDRESS:	22214 VANOWEN STREET		TELEPHONE:	(818) 300-4994
CITY:	WOODLAND HILLS	STATE: CA	ZIP CODE:	91303
CAPACITY:	6	CENSUS: 3	DATE:	01/19/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:18 AM
MET WITH:	Rachel		TIME COMPLETED:	01:00 PM

NARRATIVE

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At approximately 9:18 AM on 01/19/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual visit using the Infection Control Domain. LPA met with staff and disclosed the reason for the visit.

Census: 3

Entry: Upon entry, LPA met with staff and heard an auditory alarm when the front door opened. LPA did not observe signs regarding the facility’s visitation policy posted on the front door. Staff told LPA of a recent Technical Assistance Visit from Public Health in which staff were told there was no longer a need for the signs. LPA recommended the signs be replaced at the front entry.

Screening: Staff took LPA’s temperature and requested documentation in the visitor log. LPA observed a visitor log with names, temperatures, and times of visits. LPA recommended staff also screen all visitors for symptoms of COVID-19 and document. Staff adjusted the visitor log to include symptom checks Staff noted all visitors show proof of vaccination and proof of a recent, negative COVID test.

Common Areas: LPA observed common areas to be clean and tidy. Floors were clean and furniture was in good repair. Signs related to COVID-19 precautions, such as Cough Etiquette, Signs and Symptoms, Handwashing Instructions, Cleaning Procedures, and Droplet Precautions, were present throughout.

Kitchen: LPA observed cleaning supplies locked in a cabinet below the kitchen sink. LPA recommended all sinks have Handwashing Instructions signs posted nearby, and staff made the adjustment immediately. Staff noted residents stagger meal times or eat in a socially distanced fashion.

Laundry: LPA observed two laundry machines near staff rooms by the eastern side of the facility. Staff sanitize the machines between loads using bleach and sanitizing wipes.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2022

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: BEWISE HOME	FACILITY NUMBER: 197609568
	VISIT DATE: 01/19/2022

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Bedrooms: The facility has 5 bedrooms in total. 3 bedrooms are designated for residents and 2 bedrooms are for staff. Bedroom #1 is occupied and private, Bedroom #2 is vacant and private, and Bedroom #3 is occupied and shared. All bedrooms were clean and orderly. Bedroom #2 was locked and contained a sharps disposal bucket. Bedroom #3 had beds which were at least 6 feet apart.

Bathrooms: LPA observed 2 bathrooms. One is adjacent to Bedroom #3 and contained fully stocked soap, toilet paper, and a shower with a seat and a non-skid mat. Since the bathroom is used by one resident, there is a personal use towel for drying hands. The bathroom for staff and other residents contained liquid soap, a shower with a non-skid mat, and a trash can with no lid. LPA recommended the facility acquire a trash can with a tight-fitting lid for infection control purposes.

Isolation: LPA spoke with staff about infection control practices in case of a COVID positive resident. Staff noted they would isolate in the facility with residents due to their live-in status. All meals and medication could be provided to residents in care. Staff have been trained on PPE donning an doffing. The vacant bedroom could be used for isolation purposes.

LPA conducted exit interview and issued a copy of report.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2022

LIC809 (FAS) - (06/04)

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