197610114-2-22-2022-31-AS-NRED-CBVT87-20220222132953

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610114
Report Date: 02/22/2022
Date Signed: 02/22/2022 01:30:03 PM

COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/22/2022 01:30 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:	ANGELA'S CARE VILLA		FACILITY NUMBER:	197610114
ADMINISTRATOR:	GUNATILAKE, SHENELLE J		FACILITY TYPE:	740
ADDRESS:	18908 STRATHERN STREET		TELEPHONE:	(818) 414-1175
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY:	6	CENSUS: 0	DATE:	02/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Shenelle Gunatilake		TIME COMPLETED:	01:40 PM

NARRATIVE

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At approximately 12:45 PM on 02/22/22, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with Administrator and disclosed the reason for the visit.

Census: 0

Due to the COVID-19 pandemic, the facility has not yet served residents.

The facility had 3 bedrooms, 2 bathrooms, a living room, a dining room, garage, and outdoor area.

Bedroom #1 and Bedroom #2 were near the front entrance of the facility. Both bedrooms contained beds with adequate fresh linens, nightstands, lamps, and storage space. Both bedrooms also contained sliding glass doors as emergency exits. Bedroom #3 is a staff bedroom. Smoke detectors tested in Bedroom #1 and Bedroom #2 were functional.

Bathroom #1 was in the hallway by Bedroom #2. Bathroom #2 was adjacent to Bedroom #3. Bathrooms contained adequate supplies of paper towels, liquid soap, and trash cans.

All common areas and rooms were tidy, clean, and free from debris. The facility has a fireplace which is covered by a metal grate. The garage was accessible from the living room and was free from hazards.

The kitchen contained adequate supplies of perishable and non-perishable food. The kitchen also contained a fully charged fire extinguisher. Water temperature tested at 108.8 degrees Fahrenheit.

Outdoors: The facility has emergency exit paths on both sides. There was a covered patio area with furniture in good repair. Trees and planter areas were also well maintained.

LPA conducted exit interview and issued report.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2022

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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