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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610130
Report Date: 12/27/2023
Date Signed: 12/27/2023 10:59:45 AM

Document Has Been Signed on 12/27/2023 10:59 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
WOODLAND HILLS S.RO, 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: 2DATE:
12/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Okeoghene OkiyaTIME COMPLETED:
11:20 AM
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At 08:25 a.m., Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, annual visit. LPA was met by Okeoghene Okiya, Program Supervisor. The Regional Director was called and arrived at 10:10 a.m. Idirs Danesi.

A tour of the physical plant was conducted at 09:20 am.

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 in the bathrooms.

The facility temperature was at 71 degrees.

Laundry area is in living room behind curtains and observed to be clean with folded linen stored on shelves above one washer and one dryer. There is a fire extinguisher against the wall fully charged and is dated November 2023. The smoke/carbon monoxide detectors are hardwired and interconnected and observed to be functional. There is also a single, carbon monoxide located against the wall in the living room area.

Living and dining room furniture is accessible for two (2) clients. There is a television and enough seating for two (2) clients. There is internet accessibility a phone line available for client use. Furniture was observed to be in good condition and the fireplace has a covering around it. The disaster plan is located against the wall in a frame in the living room area. There is other signs such as the program schedule, activity schedule, YES sign, House Rules and Rights with Individuals with Developmental Disabilities.

LIC 809-C continued

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2023
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: REM CALIFORNIA LLC - BAIRD
FACILITY NUMBER: 197610130
VISIT DATE: 12/27/2023
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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. The sharps and toxins are kept secured and locked in one of the cabinets in the kitchen inaccessible to clients. There is one fire extinguisher located against the wall in the kitchen area fully charged and dated November 2023.

Medications-LPA observed medication stored in another cabinet cart locked and secured in the kitchen area against wall and inaccessible to clients.

Bedrooms: There is four (4) bedrooms. Two are vacant and two are single, occupied. The client bedrooms were properly furnished with at least one chair, nightstand, and sufficient lighting for each client.

Bathrooms: LPA observed two (2) bathrooms that were clean, properly supplied and had functional fixtures. LPA observed grab bars and non-skid mats in all bathrooms. Clients have extra supplies for personal hygiene in one of the cabinet areas in the kitchen. LPA measured the hot water between the required limit of 109.1 and 110.5 degrees Fahrenheit during time of visit.

The garage is detached and was observed to be locked and used to store surplus food, PPE, and water. There are client properties in individual bins. There are also two (2) refrigerators in the garage with extra food.

There is backyard which has outdoor furniture and grassy area for outdoor activities. There is no pool.

LPA reviewed files for the two (2) residing, female clients. Staff files were also reviewed.

Administrative: There is no annual fee due. The surety bond and the Insurance plan are updated.



An exit interview was conducted, no citations 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: 12/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023
LIC809 (FAS) - (06/04)
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