197609811-8-9-2021-31-AS-APAA-C5QMDQ-20210809093129

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609811
Report Date: 07/23/2021
Date Signed: 08/09/2021 09:32:10 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	LAND OF PEACE 6		FACILITY NUMBER:	197609811
ADMINISTRATOR:	ROSELIN FINULIAR		FACILITY TYPE:	740
ADDRESS:	22626 KITTRIDGE STREET		TELEPHONE:	(818) 884-2214
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY:	6	CENSUS: 5	DATE:	07/23/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Administrator Roselin Finuliar		TIME COMPLETED:	01:38 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	At 11:25am Licensing Program Analyst (LPA) Angela Panushkina, conducted an unannounced annual inspection at the above facility. LPA met with the caregiver Emma Dizon who granted access to home. Shortly after, around 11:45am, the Administrator arrived. LPA toured the entire facility with the Administrator and observed the following: This is a 6 bedroom, 3 and 1/2 bathroom, single story family residence that includes a living room, dining area, kitchen, laundry room and attached garage. Infection control: LPA Panushkina reviewed facility mitigation plan (approved on 01/29/21) to make sure licensee was following current infection control recommendations. There are required posters posted at the main door. LPA was screened upon entry. Screening area is located in the living room area. Sign in sheet, hand sanitizer, gloves and masks are available. All staff were observed to be wearing mask upon entrance and during visit. Food Inspection: At 12:00pm LPA conducted a food inspection tour an found the following. Supplies of staple non-perishable for minimum 1 week and perishable for 2 days maintained on premises. In between meals snacks is available in the facility. The kitchen knives were observed locked and inaccessible to residents in care. There is one carbon monoxide detector in the hallway by the living room area. Smoke detectors were checked and are hardwired throughout the facility. Smoke detectors and carbon monoxide are observed to be operational. Bedrooms: There are five bedrooms designated for residents' use and have sufficient lighting and one bedroom is designated for live in staff. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Auditory alarms are in good repair and operating properly.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021

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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LAND OF PEACE 6	FACILITY NUMBER: 197609811
	VISIT DATE: 07/23/2021

NARRATIVE

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Bathrooms: At 12:20pm LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. The hot water temperature measured at 116.3F. LPA observed appropriate grab bar and all showers had non-skid mat. LPA observed appropriate hand washing signs posted in each bathroom. All trash cans in bathrooms had lids.
Common Areas: The facility maintains a comfortable temperature at 76F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. There is a fire extinguisher in the laundry area and was last serviced on 05/13/21.
Surrounding Grounds: LPA toured the outside area of the facility. There are no bodies of water. There are no visible hazards, and passageways are free from obstruction. Gate was unlocked and easily accessible to open. LPA observed appropriate outdoor furniture, with a covered shaded area for the residents.
The garage is attached to the home and is kept locked inaccessible to residents.
Medications: Centrally stored medications kept in a safe locked place that is not accessible to persons other than employees responsible for the supervision of the medication.
Administrative: LPA collected Certificate of Liability Insurance, Administrator Certificate and LIC.500. Annual fees are current.

Exit interview

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021

LIC809 (FAS) - (06/04)

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