197609933-1-13-2023-31-AS-MCAA-CN2QEN-20230113110638

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609933
Report Date: 01/13/2023
Date Signed: 01/13/2023 11:06:45 AM

Document Has Been Signed on 01/13/2023 11:06 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:	BZ HOMES, INC		FACILITY NUMBER:	197609933
ADMINISTRATOR:	AKSELRUD, ZINAIDA		FACILITY TYPE:	735
ADDRESS:	20601 BRYANT STREET		TELEPHONE:	(310) 308-4820
CITY:	WINNETKA	STATE: CA	ZIP CODE:	91306
CAPACITY: 4		CENSUS: 3	DATE:	01/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Jackline Tumwebaze		TIME COMPLETED:	11:15 AM

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	Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with staff, Jackline Tumwebaze and explained the reason for the visit. At approximately 9:30am, with the assistance of staff, LPA took a tour of the physical plant. Facility is a one story building with four (4) bedrooms and two (2) bathrooms. Required postings were observed at the entry area. The smoke alarms are hardwired. The carbon monoxide detector is located in the hallway, near the client rooms. It appears to function properly. The fire extinguisher is new and is located in the kitchen. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. There is also an emergency supply of food and water stored in the garage. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets. Bedrooms: There were four (4) bedrooms designated for residents' use. All rooms are private. All four rooms were properly furnished with appropriate beddings and linens with sufficient lighting. Although it was observed to by fully furnished, Room 1 (Rm1) is vacant at this time. Bathrooms: There are two (2) bathrooms designated for residents' use. Both bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 113 degrees Fahrenheit. There were no cleaning supplies stored underneath the bathroom sinks. Common Areas: These included the living room and dining area. The common areas were properly furnished. Floors and furniture were observed to be clean and maintained. Entry and exits were clear of obstruction.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

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

FACILITY NAME: BZ HOMES, INC	FACILITY NUMBER: 197609933
	VISIT DATE: 01/13/2023

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
26
27
28
29
30
31
32

Surrounding Grounds: Entry/exits were free of obstruction. There was furniture in the backyard appropriate for outdoor use. There was also gym equipment available for client use. The facility has no swimming pool. The outdoor area was observed free of any hazards. The laundry area and detergents is located in the garage.

Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

Medications: Medication and Medication Records were review for proper documentation.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2