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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609892
Report Date: 12/19/2023
Date Signed: 12/19/2023 11:32:55 AM

Document Has Been Signed on 12/19/2023 11:32 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:BEWISE HOME COVELLOFACILITY NUMBER:
197609892
ADMINISTRATOR:OKONKWO, CHINWEIKEFACILITY TYPE:
735
ADDRESS:20616 COVELLO STREETTELEPHONE:
(818) 300-4994
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY: 4CENSUS: 4DATE:
12/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Chinweike OkonkwoTIME COMPLETED:
11:35 AM
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At 8:40 a.m. on 12/19/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and later the licensee and disclosed the reason for the visit.

The facility was last visited on 11/09/2022 for an annual inspection. It is a single story building with four (04) bedrooms, two (02) bathrooms, kitchen. garage, common areas, office, and outdoor areas. It has an approved fire clearance for six (06) ambulatory clients and an approved capacity for four (04) clients.

LPA conducted a file review of staff and client records at 9:15 a.m.

LPA and staff toured the facility inside and out at 10:00 a.m. No immediate health and safety hazards were observed during this visit.

At the main entrance, LPA a screening station containing a visitor log, cleaning wipes, hand sanitizer, gloves, and masks. LPA observed postings for emergency contacts, confidential complaint contacts, personal rights, COVID precautions, grievance policy, house rules, administrator certificate, facility license, activity schedule, facility sketch with evacuation routes clearly labeled, and the emergency disaster plan.

All emergency exit paths were free from obstructions. Two (02) out of two (02) exit gates were unlocked with self-closing latches. Evacuation routes were posted. At approximately 10:20 a.m. smoke and carbon monoxide detectors were tested and operational. At approximately 10:30 a.m. LPA observed a fully charged fire extinguisher in the kitchen.

The facility has four (04) private bedrooms. All bedrooms contained a chair, lamp, nightstand, storage, and a bed with adequate bedding. All furnishings were clean and in good condition. Bedroom #3 contained padded walls. Bedroom #4 contained a step stool to access the bed.

Walls, floors, windows, screens, and blinds were clean and in good repair. At 10:40 a.m. LPA measured the room temperature to be 75 degrees Fahrenheit. A covered activity room in the rear of the facility contained exercise equipment and additional seating. The back yard was maintained.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2023
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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: BEWISE HOME COVELLO
FACILITY NUMBER: 197609892
VISIT DATE: 12/19/2023
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LPA observed an adequate supply of perishable and non-perishable foods in the kitchen refrigerator, freezer, and pantries. Appliances were in good condition. Sharps, first aid kit, and supplies were locked above the counter. Cleaning solutions were locked below the sink. Medications were locked in a cabinet in the kitchen. Confidential files were locked in an office. A locked shed with additional supplies was located in the driveway.

The facility has two (02) bathrooms. All bathrooms contained liquid soap, paper towels, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. Bathroom #1 contained a shower seat. At approximately 11:05 a.m. LPA measured the water temperature to be 117.5 degrees Fahrenheit.

A washing machine and dryer were located in the garage. Both were in working order. Detergents were locked in a separate cabinet. The garage was also locked. At 11:15 a.m. LPA tested the house phone to be operational.

During today's inspection, the facility was in compliance with Title 22 regulations.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023
LIC809 (FAS) - (06/04)
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