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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609906
Report Date: 12/07/2022
Date Signed: 12/07/2022 01:56:27 PM

Document Has Been Signed on 12/07/2022 01:56 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:JAMISON PARKRIDGE, INC.FACILITY NUMBER:
197609906
ADMINISTRATOR:JAMISON, JANETFACILITY TYPE:
735
ADDRESS:28054 PARKRIDGE LANETELEPHONE:
(661) 309-6008
CITY:SANTA CLARITASTATE: CAZIP CODE:
91387
CAPACITY: 4CENSUS: 4DATE:
12/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Rosalinda Rapada, house managerTIME COMPLETED:
02:20 PM
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At 1:10pm, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA observed COVID-19 signage posted outside on the front door and along the main entrance. LPA met with Rosalinda Rapada who granted access to the facility and LPA explained the reason for the visit.

At 1:15pm LPA conducted a tour of the physical plant and observed the following:

Facility is an Adult Residential Facility which was licensed for four (4)) ambulatory clients. Facility has three bedrooms, three bathrooms and one staff room. LPA was able to tour the home and did not observe any immediate health and safety concerns. Sufficient PPE supplies were observed. Smoke detectors and carbon monoxide monitors were observed to be functional. Facility maintains a temperature of 70°F. LPA observed there to be sufficient stock of one-week non-perishable foods and two-day perishable foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Sharps, cleaning supplies and medications are centrally stored and are kept locked in a dining room closet by the stairs. LPA observed a fire extinguisher located in a dining area and last serviced on 10/21/2022. Bedrooms are appropriately furnished and have appropriate lighting. Bathrooms have soap, paper towels and hand washing signs were observed. Extra towels and linens were readily available. Laundry area is located by the garage and kept locked and inaccessible to clients. LPA observed a clean covered patio and backyard furniture to accommodate the four (4) clients.

No deficiencies issued during today’s visit. An exit interview was conducted and copy of this report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2022
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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