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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610130
Report Date: 03/17/2022
Date Signed: 03/17/2022 06:33:48 PM

Document Has Been Signed on 03/17/2022 06:33 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:REM CALIFORNIA LLC - BAIRDFACILITY NUMBER:
197610130
ADMINISTRATOR:FREEMAN, ELIZABETHFACILITY TYPE:
735
ADDRESS:10426 BAIRD AVETELEPHONE:
(818) 363-3333
CITY:NORTHRIDGESTATE: CAZIP CODE:
91326
CAPACITY: 4CENSUS: DATE:
03/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Elizabeth Freeman, AdministratorTIME COMPLETED:
03:27 PM
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Licensing Program Analyst (LPA) Tihesha “Lynn” Smith conducted an unannounced Required One (1) year-Infection Control inspection to the above facility. LPA was greeted by staff Eustace Pratt and explained the reason for the visit. Staff revealed administrator not available. Brittany Borne, Area Director at facility able to assist and administrator will return later.

A tour of the physical plant was conducted between: 11:20 am and 12:45 pm and the following was observed:

Signs to wear a mask and other COVID-19 prevention protocol signs were posted outside the door. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted on foyer wall, fire door, and in the bathrooms.

The facility maintains a temperature at 70 degrees observed to be adjusted based on needs of residents. Living and dining room furniture were also checked. The living room observed to be neat, clean, and sufficiently furnished. Laundry area is located in living room behind curtains and observed to be clean with folded linen stored on shelves above washer and dryer. The smoke/carbon monoxide detectors are hardwired and interconnected and observed to be functional. There was a wall mount fire extinguisher with current receipt attached in the kitchen.

Kitchen area was sufficiently stocked with two (2) days of perishable and seven (7) days of non-perishable food. Sharps are stored and double locked in cabinet and container. There were two (2) complete first aid kits stored in overhead cabinet adjacent to sharps cabinet on side of kitchen.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: REM CALIFORNIA LLC - BAIRD
FACILITY NUMBER: 197610130
VISIT DATE: 03/17/2022
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(Cont From 809)

Medications-LPA observed medication stored in a stand-alone locked medication cart in kitchen against wall and inaccessible to residents.

Bedrooms: The resident bedrooms were properly furnished with at least one chair, nightstand and sufficient lighting for each resident.

Bathrooms: LPA observed all bathrooms were clean, properly supplied and had functional fixtures. LPA observed grab bars and non-skid mats in all bathrooms. Residents have sufficient amounts of supplies for personal hygiene. LPA measured the hot water between the required limit of 105-120 degrees Fahrenheit during time of visit.

The garage which were observed to be locked and used to store surplus food, PPE, and water.

The facility grounds were free of hazards The backyard has outdoor furniture and grassy area for outdoor activities.

LPA reviewed files for the three (3) residing residents. All resident files contained medical assessments, physician orders for medications and centrally stored medication logs. Medications are given as prescribed. Staff files were also inspected. All staff files inspected had current First aid/ CPR documentation as well as the appropriate training documentation.

Exit interview conducted/report signed and delivered.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2022
LIC809 (FAS) - (06/04)
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