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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609743
Report Date: 07/09/2024
Date Signed: 07/09/2024 03:07:01 PM

Document Has Been Signed on 07/09/2024 03:07 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:ELWYN CALIFORNIA - QUARTZFACILITY NUMBER:
197609743
ADMINISTRATOR/
DIRECTOR:		STEPHEN WAMALAFACILITY TYPE:
737
ADDRESS:8033 QUARTZ AVETELEPHONE:
(925) 626-7014
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY: 2CENSUS: 2DATE:
07/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:05 AM
MET WITH:Stephen WamalaTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 07/09/2024 at 11:05 AM, Licensing Program Analyst (LPA) Gina Saucedo conducted an unannounced, Annual Inspection and met with Direct Support Professional, Mosidat Olopade. Administrator, Stephen Wamala was called and arrived about fifteen (15) minutes after. LPA asked for the census, staff and client files.

The physical plant was toured inside and out at 12:20 pm.

Living/Dining Room Area: LPA Saucedo observed the living room furniture to be clean and in good repair. The facility maintains a comfortable temperature at 77 degrees Fahrenheit with a large television.

Bedrooms: There are four (4) bedrooms. Two (2) are used for clients, One (1) for a gym and the other one (1) as an office. The gym has two (2) closets that are used for storage. It has PPE’s and toilet paper. LPA observed rooms to have bedding sheets, pillowcase, blankets, nightstands, televisions, and sufficient lighting for each of the client’s room.

Bathrooms: There are two (2) bathrooms that were toured and checked to make sure bathrooms were clean and in good repair. The hot water temperatures were measured within regulations of 118 degrees. The showers have non-slip bathmats and grab bars.

Medications were kept in a locked, auburn cabinet next to the kitchen. All medications were properly labeled and inaccessible to clients. There is a complete first aid kit located above one (1) of the white cabinets in the kitchen that is locked and inaccessible to the clients.

Outside: LPA toured the outside area. LPA observed a covered shaded area for clients and appropriate outdoor furniture. The facility has no body of water on the premises.

LIC 809C-continued

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: ELWYN CALIFORNIA - QUARTZ
FACILITY NUMBER: 197609743
VISIT DATE: 07/09/2024
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Kitchen Area: LPA inspected the kitchen area. There is one (1) refrigerator which was clean and in good operation. LPA observed sufficient supply of seven (7) day non-perishable and perishable foods in the cabinets. There is one (1) fire extinguisher fully charged and expires on September-2024. There are two (2) more fire extinguishers. One (1) in the garage and one (1) where the washer and dryer are located.

The washer and dryer are located in the hallway locked and inaccessible to the clients.

The carbon monoxide and the smoke detector were tested, and they were operable. There is also signal system at the above facility.

Garage: The garage is attached to the facility there is an access door from the kitchen area/front door area. It is used for additional storage of water, toilet paper, client property and there is an extra refrigerator. The knives/sharps are located in the garage locked and inaccessible to the clients in a black cabinet.

Administration: The Liability Insurance was reviewed and expires 07/01/2024. There are several Covid 19 signs on the wall, hygiene sanitation signs, Emergency and Disaster Plan, Rights of Individuals with Disabilities, House Rules, Grievances and Complaints are by the entrance of the facility against the wall.

An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC809 (FAS) - (06/04)
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