197610112-10-2-2024-31-AS-GSAO-D9NRNY-20241002131103

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610112
Report Date: 10/02/2024
Date Signed: 10/02/2024 01:11:20 PM

Document Has Been Signed on 10/02/2024 01:11 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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	CREBS COMPASSION HOME		FACILITY NUMBER:	197610112
ADMINISTRATOR/ DIRECTOR:	MOSES T BAHINGIRE		FACILITY TYPE:	735
ADDRESS:	9343 BALCOM AVE		TELEPHONE:	(818) 324-9589
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY: 4		CENSUS: 4	DATE:	10/02/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:35 AM
MET WITH:	Moses Bahingire		TIME VISIT/ INSPECTION COMPLETED:	01:15 PM

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On 10/02/24, at 9:35am Licensing Program Analyst (LPA) Gina Saucedo conducted an unannounced, Annual Inspection and met with Caregiver,Winfred Kyokunzire. LPA asked for the census, staff and resident files.

The physical plant was toured inside and out at 10:50 am.

Living/Dining Room Area: LPA observed the living room furniture to be clean and in good repair. The facility maintains a comfortable temperature at 72 degrees Fahrenheit with a large television.

Bedrooms: There are six (6) bedrooms. Four (4) bedrooms are used for residents and are located downstairs. There are two (2) bedrooms that are used for staff. The two (2) bedrooms for staff are located upstairs. LPA observed rooms to have bedding sheets, pillowcase, blankets, nightstands, televisions, and sufficient lighting for each of the resident’s room.

Bathrooms: There are five (5) bathrooms that were toured and checked to make sure bathrooms were clean and in good repair. There are four (4) private bathrooms and one (1) bathroom in the hallway. Two (2) of the staff rooms have private bathrooms and two (2) of the residents rooms have private bathrooms. The hot water temperatures were measured within regulations of 110-114 degrees. The showers have non-slip bathmats and grab bars.

Medications and Knives: are located at the entrance of the facility on your left-hand side locked and inaccessible to the residents.

There is also a signal system in the facility. There are one (1) fire extinguisher fully charged and expires on April-2025 that is located in the kitchen area.

LIC809C-continued

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024

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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CREBS COMPASSION HOME	FACILITY NUMBER: 197610112
	VISIT DATE: 10/02/2024

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Kitchen Area: LPA inspected the kitchen area. There is one (1) refrigerator and one (1) freezer which was clean and in good operation in this area. LPA observed sufficient supply of seven (7) day non-perishable and perishable foods in the cabinets.

The chemicals are locked in a room inaccessible to the residents by the living room area.

Outside: LPA toured the outside area. LPA observed a covered shaded area for residents and appropriate outdoor furniture. The facility has no body of water on the premises. There is one (1) gate that is unlocked leading to the outside area towards the street.

The carbon monoxide and the smoke detector were tested, and they were operable, interconnected.

There is one (1) washer and dryer that lead to the garage area. The garage area has one (1) extra refrigerator and one (1) extra freezer. There is also a small refrigerator upstairs where one (1) of the resident's insulin is kept. The resident's are not allowed upstairs.

Administration: The Liability Insurance was reviewed and will be renewed on 12/2024. There are several Covid 19 signs on the wall, hygiene sanitation signs, and the Rights of Individuals with Developmental Disabilities, Emergency Disaster Plan and Facility Sketch signs against the wall at the entrance of the facility.

An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024

LIC809 (FAS) - (06/04)

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