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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610112
Report Date: 11/29/2022
Date Signed: 11/29/2022 02:25:36 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/29/2022 02:25 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:CREBS COMPASSION HOMEFACILITY NUMBER:
197610112
ADMINISTRATOR:MOSES T BAHINGIREFACILITY TYPE:
735
ADDRESS:9343 BALCOM AVETELEPHONE:
(818) 324-9589
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 4CENSUS: 4DATE:
11/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Fatuma Nassanga TIME COMPLETED:
02:30 PM
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On 11/29/22 Licensing Program Analysts (LPA) Joscelyn Martinez conducted an unannounced annual inspection at the facility mentioned above. LPA was greeted by staff who granted access to the home. LPA 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: 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. Hand sanitizer was available outside. All trash cans were observed to have closed tight fitting lids. Sufficient PPE supplies were observed. 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 2:00 pm, they were tested and are functional. Fire extinguisher was observed to be charged with a service date of 03/31/22. Common Area: Common area were observed to be clean with appropriate furniture. Facility maintains a comfortable temperature of 72.0 F. Client rooms: There are four (4) bedrooms designated for client 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 106.7 F. Towels and washcloths are not shared. Bathrooms were observed to be clean and trash cans have tight fitting lids. The garage is attached to the home and is used for storage, and has a separate laundry room. Outside area: LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. There are no bodies of water.

No deficiencies cited. A copy of this report was provided. Exit interview conducted.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Joscelyn Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2022
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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