197609933-3-2-2024-31-AS-JGTN-D2YVRH-20240302153958

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609933
Report Date: 03/02/2024
Date Signed: 03/02/2024 03:40:25 PM

Document Has Been Signed on 03/02/2024 03:40 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:	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:	03/02/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:14 PM
MET WITH:	Zinaida Akselrud - Administrator		TIME COMPLETED:	03:45 PM

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) Gary Tan conducted an One (1) year required visit and inspection of the facility. LPA initially met Saphrah Ayesigamukama who called the administrator and explained the reason for the visit. Administrator Zinaida Akselrud and Boris Gerzenshtein arrived thirty (30) minutes later. A tour of the physical plant was conducted at 12:23 PM and the following was noted: There is only one entrance being utilized at the facility, there are required poster posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Infection Control and Mitigation plan. Signs to wear a mask and other Covid 19 prevention protocol signs were posted outside the doors. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room. The Facility is a one (1) storey building with four (4) bedrooms and two (2) bathrooms. The smoke alarms are hardwired and interconnected, tested and observed to be operational. The carbon monoxide detector is located along the bedroom hallway also tested and operational. The fire extinguisher full and current. 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 toolbox inside a locked drawer in the kitchen. 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. 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 113.6°F.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2024

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: BZ HOMES, INC	FACILITY NUMBER: 197609933
	VISIT DATE: 03/02/2024

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(continued from LIC 809)

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.

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. There is a tool shed located in the backyard. The shed was observed to be locked. Garage is attached to the house and was observed to be locked. The garage is also being used as a Laundry area, emergency food and old equipment storage. Laundry detergents and other cleaning agents and toxins are locked in a cabinet inside the garage by the laundry area.

Resident Files: LPA conducted a file review of resident records to ensure compliance of licensing forms. Resident files appeared to be complete and updated.

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: Medications were observed to be locked in the kitchen cabinet Medication Records were reviewed for proper documentation.

Disaster drill was last conducted on 02/20/24. Required posting are observed to be complete and current and displayed properly at the facility.

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: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2024

LIC809 (FAS) - (06/04)

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