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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609781
Report Date: 12/01/2023
Date Signed: 12/01/2023 03:42:32 PM

Document Has Been Signed on 12/01/2023 03:42 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:ZELZAH COMPASSION HOMEFACILITY NUMBER:
197609781
ADMINISTRATOR:NASSANGA, FATUMAFACILITY TYPE:
735
ADDRESS:9200 ZELZAH AVETELEPHONE:
(818) 324-9589
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 4CENSUS: 2DATE:
12/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:FATUMA NASSANGA- AdministratorTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with House Manager Stephen Kamukama and explained the reason for the visit. Administrator, Fatuma Nassanga has joined shortly after. At approximately 10:15 am, with the assistance of staff, LPA took a tour of the physical plant. Required postings were observed in the entry area. Smoke detectors/carbon monoxide are located throughout the facility and are hardwired. Smoke detectors and carbon monoxide detectors were tested and appear to be functional. The fire extinguisher is located in the living room and the charge date is May 4, 2023. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked area. Properly labeled medications were locked in one of the entry cabinets. Bedrooms: Facility has six (6) bedrooms which of two (2) are designated for client use. All bedrooms, in use by clients, were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are three (3) bathrooms in the facility of which two (2) are designated for client's use. LPA observed all bathrooms to have grab bars and non-skid mats. The hot water was tested and measured at 110.8 and 113.3 F. All trash cans located in the bathrooms had tight fitting lids. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Common Areas: These included the living room and dining area. The common areas were properly furnished. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The laundry area is located in the garage, and all detergents are locked and inaccessible to clients. Resident Files: LPA conducted a file review of clients records to insure compliance of licensing forms. Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.
Medications: Medication and Medication Records were review for proper documentation.
Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2023
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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