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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609962
Report Date: 08/16/2021
Date Signed: 08/16/2021 10:03:24 AM

Document Has Been Signed on 08/16/2021 10:03 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:AMBIENCE RESIDENTIAL HOMEFACILITY NUMBER:
197609962
ADMINISTRATOR:TURYASIIMWA, ASSUMPTAHFACILITY TYPE:
735
ADDRESS:7943 NEWCASTLE AVETELEPHONE:
(818) 578-8757
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 4CENSUS: 0DATE:
08/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:Meddy KisekkaTIME COMPLETED:
10:30 AM
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An infection control/ annual visit was conducted by Licensing Program Analyst (LPA), Patrick Shanahan. The LPA met with Meddy Kisekka . The facility still does not have any residents at the facility.

LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. First-aid kit is complete; facility has adequate linen, perishable and nonperishable food supplies. There is no swimming pool or other body of water present. Facility has working alarms on all exits. The backyard is completely fenced and gated with self-latching mechanisms. There is patio area backyard with table and chairs for resident use. All chemicals and sharps are in locked cabinets and drawers. Facility has 2 bathrooms. Fire Clearance is approved for 4 ambulatory residents. There are 4 single rooms and no staff room. The washer and dryer are located in a hallway next to the kitchen.

Although there are no residents, the facility does have signs posted in all common areas and bathrooms. The administrator was not present at the time of the visit but the report was emailed to the administrator.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Patrick Shanahan
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2021
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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