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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609804
Report Date: 07/25/2024
Date Signed: 07/25/2024 12:30:00 PM

Document Has Been Signed on 07/25/2024 12:30 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:ALLIANCE ADULT RESIDENTIAL HOMES INCFACILITY NUMBER:
197609804
ADMINISTRATOR/
DIRECTOR:		WAKABI, MOSES DFACILITY TYPE:
735
ADDRESS:7821 HESPERIA AVENUETELEPHONE:
(747) 254-4154
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 4CENSUS: 4DATE:
07/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Mosis Wakabi, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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At 09:45 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced annual inspection. LPA met with the staff Patrick Mugenyi, and the Administrator arrived later. LPA disclosed the reason for the visit. LPA and Administrator toured the facility inside and out.

It is a single story building with four (4) bedrooms, two (2) bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 4 ambulatory clients.

Kitchen: LPA observed an adequate supply of perishable and non-perishable food in fridges and freezers. Stove burners were functional. All surfaces were sanitary. Sharp objects, laundry detergents, and cleaning solutions were locked below the sink. At 10:27 AM, LPA observed a fully charged fire extinguisher in the kitchen. A receipt from 07/31/2023 was taped on the fire extinguisher.

Medications: At 10:30 AM, LPA observed medications were locked in a closet near the main entrance. A complete First Aid Kit was observed.

Common Areas: Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. At 10:32 AM LPA measured the room temperature to be 72 degrees. LPA observed postings in the dining room for the facility’s house rules, grievance procedures, Emergency Disaster Plan, facility sketch, personal rights, and COVID related signs.

Bedrooms: The facility has four (4) bedrooms. All bedrooms are private. All bedrooms contained a nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition.

Bathrooms: The facility has two (2) bathrooms. All bathrooms contained liquid soap, paper towels, trash can with a lid, and a non-skid mat in the shower. At 10:35 AM, LPA measured the water temperature in Bathroom #1 to be 119.5 degrees Fahrenheit. Continue on LIC 809C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2024
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: ALLIANCE ADULT RESIDENTIAL HOMES INC
FACILITY NUMBER: 197609804
VISIT DATE: 07/25/2024
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Garage: At 10:37 AM, LPA observed a washer and dryer in working condition. Detergents were separately locked in the kitchen cabinet under the sink. Extra water, paper supplies, PPE, and additional refrigerators and freezers were also stored in the garage.

Outdoor areas: A covered patio area contained furniture in good repair. The rear black gate was locked with a deadbolt. The gate allowed access to the back alley. A bicycle and a scooter were observed in the back yard.

Smoke detectors/carbon monoxide. At 10:42 AM, LPA tested the dual-purpose smoke and carbon monoxide detector to be operational. LPA heard auditory alarm function for three (3) out of three (3) facility doors.

Between 11:20 AM to 12:30 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: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024
LIC809 (FAS) - (06/04)
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