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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609692
Report Date: 02/15/2024
Date Signed: 02/15/2024 01:35:41 PM

Document Has Been Signed on 02/15/2024 01:35 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.RO, 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: 2DATE:
02/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Pradeep Rawate, AdministratorTIME COMPLETED:
02:00 PM
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At 10:20 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced annual inspection. The facility was locked, and LPA contacted the Administrator via phone and disclosed the reason for the visit. Administrator arrived at the facility at 10:52 AM. Physical tour was conducted with the Administrator at 10:55 AM, and LPA observed the following:

Census: 2

Kitchen: At approximately, 10:56 AM LPA 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 kitchen drawer. At 11:15 AM, LPA observed a fully charged fire extinguisher in the kitchen and last serviced on 01/08/2024.

Medications: At approximately, 10:58 AM LPA observed medications are centrally stored and locked near the kitchen in a standing cabinet.

Bedrooms: The facility is fire cleared for four (4) ambulatory clients. has four (4) private bedrooms. Two (2) out of four (4) bedrooms are vacant. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Facility has awake staff.

Bathrooms: LPA observed two (2) bathrooms and both appeared to be clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and client's bathroom had non-skid mat. LPA observed appropriate hand washing signs posted in each bathroom. At 11:11 AM, Hot water temperature measured at 115.2°F.

Continue on LIC809-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2024
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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: RAWATES INC
FACILITY NUMBER: 197609692
VISIT DATE: 02/15/2024
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Common Areas: The facility maintains a comfortable temperature at 72°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility. The garage is currently being used for storage for extra furniture.

Outside areas: At approximately, 11:16 AM LPA toured the outside area of the facility. LPA 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. At 11:17 AM, LPA observed a locked laundry area with functioning machines and detergents locked away. Additionally, LPA observed an outdoor basketball hoop for clients use.

Smoke detectors/carbon monoxide. Smoke detectors were located throughout the facility, and at 11:20 AM they were tested and observed to be operational. The carbon monoxide and smoke detectors are wire connected and observed to be operational.

Between 12:10 AM to 1:30 PM, LPA reviewed records of two (2) clients and two (2) staff. Client and staff records appeared to be complete and updated.

Administrative: LPA collected Certificate of Liability Insurance, and LIC500.

No deficiency cited during today’s visit.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC809 (FAS) - (06/04)
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