197609906-12-21-2023-31-AS-TCAS-CYQSG5-20231221125121

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609906
Report Date: 12/21/2023
Date Signed: 12/21/2023 12:52:10 PM

Document Has Been Signed on 12/21/2023 12:52 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.ASC, 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: 2	DATE:	12/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Rosalinda Rapada, house manager		TIME COMPLETED:	01:00 PM

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Licensing Program Analyst (LPA), Tuesday Cabiness a conducted an unannounced annual inspection. LPA met with house manager Rosalinda Rapada, and informed her the reason of the visit. Administrator Janet Jamison was also notified regarding the visit. The current census is (4); but during the visit, there were(2) clients present; but left the facility to go out in the community. LPA observed Licensing and COVID signs posted throughout the facility.

The following inspection included: All smoke alarms and carbon monoxide were tested and functioning properly. Fire extinguishers were charged. Disaster drills are conducted every quarterly, the last disaster drill was conducted June 2023. First aid kit was missing a current or updated manual. LPA requested them to purchase a current one.

Kitchen: LPA toured the kitchen area and observed enough supplies of 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. There are (2) extra freezers and refrigerators located in the garage, stocked with food. Chemicals and toxins are locked and secured in the laundry room.

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. (1) room is used for staff.

Bathrooms: 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 105.8. 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: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: JAMISON PARKRIDGE, INC.	FACILITY NUMBER: 197609906
	VISIT DATE: 12/21/2023

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Surrounding Grounds: There was furniture appropriate for outdoor use. All passageways were free of obstruction. There was no swimming pools or other bodies of water. Gates were easily accessible and open.

Resident Records: Clients files were reviewed; LPA checked resident files for updated appraisals and other required documents observed in the file. LPA observed (Client #1) not to have a completed physician report. A technical violation was issued and LPA requested an completed and signed report. Clients are vaccinated and records were in files.

Cash Resources: Logs and cash resources were consistent; there were no discrepancies observed.

Medications: Medications are consistent with the logs on file. Doctor's orders for medications are in file. PRN log is maintained medications are given as prescribed.

Staff Records: Staff files included first aid certifications and staff have criminal record clearance; as well as current training records. Staff are vaccinated and documents were in files.

Technical Violation issued/Exit Interview Conducted / A Copy of the Report Issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

LIC809 (FAS) - (06/04)

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