197609756-12-4-2024-31-AS-GSAO-DBMR55-20241204114231

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609756
Report Date: 12/04/2024
Date Signed: 12/04/2024 11:42:37 AM

Document Has Been Signed on 12/04/2024 11:42 AM - 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:	COMPASSION HOME		FACILITY NUMBER:	197609756
ADMINISTRATOR/ DIRECTOR:	NUSIFA BAHINGIRE		FACILITY TYPE:	735
ADDRESS:	17726 COMMUNITY ST		TELEPHONE:	(818) 324-9589
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY: 4		CENSUS: 4	DATE:	12/04/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:25 AM
MET WITH:	Fatuma Nassanga		TIME VISIT/ INSPECTION COMPLETED:	11:45 AM

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On 12/04/24 at 9:25 AM, Licensing Program Analyst (LPA) Gina Saucedo, arrived to conduct an unannounced, annual inspection at the facility. Upon arrival, LPA Saucedo met with caregiver Emmanuel Arinaitwe and disclosed the purpose of the visit. The caregiver called Fatuma Nassanga the licensee and they arrived about fifteen (15) minutes after.

LPA asked for the census, client, and staff rosters.

A physical tour was conducted at 9:55 AM with the licensee and observed the following:

The Kitchen area was toured, and LPA observed there to be sufficient seven (7) day supply of non-perishable foods and perishable food for all residents. The kitchen area was clean at the time of the tour. The fire extinguisher is located against the wall on your left-hand side. It is fully charged. The expiration date is 05/2024. There is a telephone line on the counter in the kitchen. There is extra, food in the kitchen pantries. The sharps are locked and inaccessible to the clients in one of the lower cabinets on your right-hand side. The medication is on the top of one of the cabinets locked and inaccessible on your right-hand side of the kitchen. The first aid kit is on the kitchen counter.

Outside/Backyard: The outside/backyard has furniture for the clients with proper seating. The facility does not have a signal system. The facility does not have a pool/body of water.

The dining room area is located next to the kitchen where there is enough seating for the clients and the staff.

There are two (2) living room area with a separation both having a large television, proper seating, and internet access. There is a fireplace with a covering inaccessible to the clients.

LIC 809C-continued

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

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: COMPASSION HOME	FACILITY NUMBER: 197609756
	VISIT DATE: 12/04/2024

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The garage is detached from the house used as a storage. There is also a shed used for storage.

There are cabinets in the hallway that have extra linen and chemicals stored locked and inaccessible to the clients. The house temperature is at 77-degree Fahrenheit.

The carbon monoxide and smoke detectors are located throughout the facility and are operable.

There is one washer and dryer located on the left side of the kitchen.

Bedrooms: There are four (4) bedrooms and two (2) bathrooms. The four (4) of the bedrooms are single, occupied and the other two (2) bedrooms are shared down the hallway. All bedrooms and bathrooms were toured and were properly furnished and have appropriate bedding, linens, toiletry, and lightning. The bathrooms have proper toiletry and grab bars. The bathroom temperatures of the water are within regulations reading at 116-118-degree Fahrenheit.

There is a section in the house dedicated for staff use. There are three (3) staff bedroom, a bathroom, and a small kitchen inside the section. LPA had access to this area.

Administrative: There is no annual fee that is due right now. At the entrance of the facility on your right-hand side there is a YES sign, facility sketch, House Rules, Disaster Plan, Covid signs, Rights of Individuals with Developmental Disability and Activity Schedule. The surety bond was current and expires in 2025.

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

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC809 (FAS) - (06/04)

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