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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610035
Report Date: 03/14/2024
Date Signed: 03/14/2024 02:54:53 PM

Document Has Been Signed on 03/14/2024 02:54 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:MONTARE AT THE BOULEVARDFACILITY NUMBER:
197610035
ADMINISTRATOR:JOHNSON, LIONELLFACILITY TYPE:
772
ADDRESS:4944 LINDLEY AVETELEPHONE:
(203) 823-8588
CITY:ENCINOSTATE: CAZIP CODE:
91316
CAPACITY: 6CENSUS: 5DATE:
03/14/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Denise Ojarigi, Chief Operating OfficerTIME COMPLETED:
03:25 PM
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At 01:30am, Licensing Program Analysts (LPAs) Angela Panushkina and Leslie Ngo-Castaneda, conducted a Case Management - Legal/Non-compliance visit and inspection of the facility to ensure facility compliance. LPAs met with the Chief Operation Officer and explained the reason for the visit.

On February 29th 2024, a Non-Compliance Conference (NCC) was held at the Woodland Hills Regional Office. As a result of that NCC, the facility was placed on a two-year compliance plan.

Today’s focus was Health Related Services, Personal Rights and Plan of Operation (Medication Policy)

At 2:00pm, LPAs conducted a physical plant tour to the medication room and observed that In order to gain entrance/ access into the medication room, the staff had to unlock the door with an electronic keypad door lock that required a six (6) digit code. Upon entry, LPAs observed all medications kept locked in a medication cabinet was inaccessible to clients in care. LPAs also reviewed facility's Plan of Operation and Medication Policy. Lastly, LPAs were informed that all staff completed medication training on 02/07/2024 and 02/08/2024 and copy's of all training were provided.


Exit Interview conducted and copy of this report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2024
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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