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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610112
Report Date: 10/11/2021
Date Signed: 10/11/2021 11:12:43 AM

Document Has Been Signed on 10/11/2021 11:12 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:CREBS COMPASSION HOMEFACILITY NUMBER:
197610112
ADMINISTRATOR:NASSANGA, FATUMAFACILITY TYPE:
735
ADDRESS:9343 BALCOM AVETELEPHONE:
(818) 324-9589
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 4CENSUS: 4DATE:
10/11/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Fatuma NassangaTIME COMPLETED:
11:30 AM
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At 10:00 am, Licensing Program Analysts (LPAs) Joscelyn Martinez and Melissa Ruiz conducted an unannounced annual inspection at the facility mentioned above. LPA was greeted by staff (S1) who granted access to the home and later met with administrator Fatuma Nassanga. This is a 6-bedroom, 5-bathroom two story adult residential facility. A physical tour was conducted at 10:30 am and observed the following: Infection control: Some Covid infection control signage was observed outside the home. Proper sinage was also observed outside in the main living room. Upon entrance, staff took LPAs’ temperature and was asked to sign-in the visitor’s log but was not asked any infection control questions. Hand sanitizer was available outside. All trash cans were observed to have closed tight fitting lids. Sufficient PPE supplies were observed. LPAs reminded licensee to review their mitigation plan with all staff to ensure all visitors are thoroughly screened upon entry. Food Inspection: LPAs observed there to be sufficient stock of one-week non-perishable foods and two-day perishable foods. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers in the kitchen. Sharps, cleaning supplies and medications are centrally stored in a locked cabinet in the hallway. Smoke detectors/carbon monoxide were located throughout the facility. At 10:37 am, they were tested and are functional. Facility maintains a comfortable temperature of 70.0 F. Resident rooms: There are four (4) bedrooms designated for resident use, two (2) bedrooms are designated for live-in staff. All bedrooms are properly furnished, cleaned and have appropriate bedding and linens. Bathrooms: The hot water temperature measured at 108.5 F. Towels and washcloths are not shared. The garage is attached to the home and is used for storage, and has a separate laundry room. Extra towels and linens were readily available. Outside areas: LPAs toured the outside area of the facility. LPAs observed appropriate outdoor furniture, with a covered shaded area for residents. There are no bodies of water. No deficiencies cited. An exit interview was conducted. A copy of this report was provided. Exit interview conducted.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Joscelyn Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2021
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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