197609906-10-22-2021-31-AS-APAA-C82P5G-20211022110043

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609906
Report Date: 10/22/2021
Date Signed: 10/22/2021 11:01:22 AM

Document Has Been Signed on 10/22/2021 11:01 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	JAMISON PARKRIDGE, INC.		FACILITY NUMBER:	197609906
ADMINISTRATOR:	JAMISON, JANET		FACILITY TYPE:	735
ADDRESS:	28054 PARKRIDGE LANE		TELEPHONE:	(661) 309-6008
CITY:	SANTA CLARITA	STATE: CA	ZIP CODE:	91387
CAPACITY: 4		CENSUS: 3	DATE:	10/22/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Janet Jamison, Administrator		TIME COMPLETED:	11:25 AM

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At 9:05am Licensing Program Analyst (LPA), Angela Panushkina conducted an unannounced annual inspection at the facility mentioned above. LPA was greeted by the Administrator, Janet Jamison, who granted access to the facility. At approximately, 9:10am physical plant tour was conducted and LPA observed the following:

Infection control: LPA reviewed the facility mitigation plan (approved on 03/20/2021) to make sure licensee was following current infection control recommendations. Upon arrival, LPA was screened and asked to sign-in the visitors’ log. In addition, LPA was asked all infection control questions. Proper signage was observed inside along the hallway and in the restrooms. Hand sanitizer was also observed. Administrator stated they have sufficient PPE supplies for clients and staff.

Kitchen: At approximately, 9:15am LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. Appliances in the kitchen appeared to be functional. All knives and sharp objects were locked and inaccessible to clients in care. Fire extinguisher was last serviced on 10/22/21.

Smoke detectors/carbon monoxide. Dual smoke and carbon monoxide detectors were located throughout the facility, and at 10:52am they were tested and observed to be operational.

Bedrooms: There are four (3) out of five (4) bedrooms designated for clients' use and have sufficient lighting. All bedrooms are properly furnished, clean and have appropriate bedding and linens.

Bathrooms: At 9:22am 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 117.9°F. LPA observed appropriate grab bars and non-skid mats as well as hand washing signs posted in each bathroom. All trash cans had fitted lids.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

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: JAMISON PARKRIDGE, INC.	FACILITY NUMBER: 197609906
	VISIT DATE: 10/22/2021

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Common Areas: The facility maintains a comfortable temperature at 79°F. The living room and dining area appeared clean and were properly furnished and the fireplace is adequately screened. No obstructions and or tripping hazards throughout the facility. Auditory alarms are in a good repair, were tested and observed to be operational. At approximately, 9:30am LPA toured the laundry area and observed all detergents kept locked.

Outside areas: At approximately 9:50am, LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. LPA discussed the importance of maintaining the care and supervision to meet the needs of clients. There are no bodies of water.

The garage: Facility has an attached garage that is used for extra PPE supplies and food storage. LPA observed garage being locked and inaccessible to clients.

Medications: At approximately, 9:25am LPA observed clients and staff records, along with the medications, are stored in a locked cabinet by the dining room area and inaccessible to clients in care. The first aid kit is readily available.

Administrative: LPA collected Certificate of Liability Insurance, and LIC.500. Annual fees are current.

Exit interview conducted and copy of this report was provided to the Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021

LIC809 (FAS) - (06/04)

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