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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609626
Report Date: 08/19/2024
Date Signed: 08/19/2024 12:43:22 PM

Document Has Been Signed on 08/19/2024 12:43 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:COMFORT HOME #1FACILITY NUMBER:
197609626
ADMINISTRATOR/
DIRECTOR:
KANGALA, EMMANUELFACILITY TYPE:
735
ADDRESS:10156 COLLETT AVETELEPHONE:
(310) 709-8299
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 4CENSUS: 3DATE:
08/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Kulwant KaurTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted an Annual Required visit and inspection of the facility. LPA met with staff, Emmanuel Opolot, who allowed LPA to enter. LPA observed (2) additional staff on duty, and clients preparing for program. Administrator Kulwant Kaur was contacted, and everyone was informed the reason of the visit.

A physical plant inspection of the inside and outside was conducted with the Administrator. LPA observed Licensing and COVID required postings. Smoke alarms and carbon monoxide were tested, and were operating properly. Fire extinguisher is located in the kitchen and was fully charged.

Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility, and stored and properly wrapped. Knives and medication were stored in a locked cabinet in the laundry room.

Bedrooms: There were four (4) bedrooms designated for clients' use. All rooms were neat, clean, and properly furnished with appropriate beddings and linens.

Bathrooms: There are three (3) bathrooms total two (2) for clients' use one (1) for staff. All bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 116.6 degrees Fahrenheit.

Common Areas: These included the living room and dining area. All areas were properly furnished, functional and clean. Temperature was comfortable and cool. Passageways were clear and unobstructed.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2024
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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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: COMFORT HOME #1
FACILITY NUMBER: 197609626
VISIT DATE: 08/19/2024
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Surrounding Grounds: Entry/exits were free of obstruction. The outdoor area was free of hazards. Gates were accessible and easy to open.

Resident Files: LPA conducted a file review of resident records. LPA observed Licensing required documents. P&I records checked; money was counted in front of LPA, no errors noted.

Staff Files: LPA also conducted a file review of staff records. LPA observed Licensing required documents. Training records were current; and last fire and earthquake drill was conducted on June 25, 2024.

Medications: Medication and records were reviewed; no errors noted.

Exit Interview Conducted / A Copy of the Report provided to Administrator Mrs. Kaur.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
LIC809 (FAS) - (06/04)
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