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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609692
Report Date: 02/01/2022
Date Signed: 02/01/2022 04:38:47 PM

Document Has Been Signed on 02/01/2022 04:38 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:RAWATES INCFACILITY NUMBER:
197609692
ADMINISTRATOR:RAWATE, PRADEEPFACILITY TYPE:
735
ADDRESS:8012 ZELZAH AVETELEPHONE:
(818) 388-2811
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 4CENSUS: 0DATE:
02/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Sujata RawateTIME COMPLETED:
04:39 PM
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At 3:25 PM on 2/1/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with Administrator and disclosed the reason for the visit. LPA conducted the inspection using the Infection Control Domain of the Compliance and Regulatory Enforcement (CARE) tools.

Census: 0

LPA observed a white gate locked by chain and padlock. Administrator noted the empty facility remains locked during the day, but all entrances will remain unlocked when clients are admitted. LPA was temperature screened upon entry. LPA advised Administrator to screen all visitors, clients, and staff for COVID-19 symptoms as well and document the results. At the front entrance, LPA observed 12 signs related to COVID-19 precautions, including Droplet Precautions, Signs and Symptoms of COVID-19, Special Visitors allowed, Cough Etiquette, and Cleaning Practices.

LPA conducted a physical plant inspection at approximately 3:45 PM.

The facility has 4 bedrooms and 2 bathrooms. All bedrooms are private bedrooms and contained adequate linens, bedding, nightstand, lamp, hygiene supplies, and a closet. Both bathrooms contained showers with grab bars as well as fully stocked soap, paper towels, trash cans with tight fitting lids, and handwashing instruction signs. LPA observed a closet with extra linens and hygiene supplies. Near the kitchen, LPA observed a locked medication area with first aid kit and PPE. In the kitchen, LPA recommended another handwashing sign by the sink. LPA observed fully stocked liquid soap and paper towels. Administrator also showed LPA an adequate supply of non-perishable food and drinking water. All common spaces were clean.

LPA toured the outside space and observed patio furniture in good repair. All walkways were clean and free from obstruction. All emergency exits were locked from the inside and could be opened with ease by clients. LPA also observed a grill without propane tank and a locked laundry area with functioning machines and detergents locked away. LPA issued copy of report and conducted exit interview.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2022
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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