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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610130
Report Date: 05/16/2024
Date Signed: 05/16/2024 03:34:19 PM

Document Has Been Signed on 05/16/2024 03:34 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/
DIRECTOR:		FREEMAN, ELIZABETHFACILITY TYPE:
735
ADDRESS:10426 BAIRD AVETELEPHONE:
(818) 363-3333
CITY:NORTHRIDGESTATE: CAZIP CODE:
91326
CAPACITY: 4CENSUS: 2DATE:
05/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:34 AM
MET WITH:Idris Danesi, Kenda Comstock, Marian OkiyaTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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In conjunction with a complaint investigation (control #31-AS-20240509145722), Licensing Program Analysts (LPAs) Mariana Agban and Michael Cava conducted an Annual Required visit and inspection of the facility. LPAs met with area directors Idris Danesi and Kenda Comstock, and staff Okeoghene "Marian" Okiya. They were advised of the annual. At this time, Kenda Comstock is the administrator designee until licensee can acquire a permanent administrator.

At approximately 10:45am, with the assistance of staff, LPA Cava took a tour of the physical plant. Required postings were observed at the entrance, and throughout the facility. The smoke alarms and carbon monoxide are dual and interconnected. The fire extinguisher is located by the kitchen. The charge date is November 13, 2023. Both the fire and emergency drills were last conducted on 04/18/24. This facility is a level four or higher Adult Residential Facility. The building is one story.

Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives are stored in a locked drawer. Cleaning supplies are locked in cabinet.

Bedrooms: There are four (4), private bedrooms designated for residents' use. Currently there are two (2) residents in care occupying room #1 and #3. Rooms #2 and #4 are vacant at this time. During the inspection, all four bedrooms were observed to be properly furnished with appropriate beddings and linens with sufficient lighting.

Bathrooms: There are two (2) bathrooms designated for residents' use. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 112 degrees Fahrenheit. No cleaning supplies were observed in either bathrooms during the day of the inspection.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: 05/16/2024
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Common Areas: These included the living room family room and dining area. The living room and family room is furnished with couches, chair, tables and television. The fireplace in the living room has a screen. It is not operational, and no tools for the fireplace were present. The dining room table is large enough to seat up to six (6) individuals. Furniture was observed to be in good repair. Floors were mopped and clean. Exits and passageways were clear.

Surrounding Grounds: Entry/exits to the front and back yards were free of obstruction. There is sufficient yard space in the back to hold activities. There is outdoor furniture appropriate for the resident's use. Gates at both sides of the home presents no exterior lock and is clear to exit/evacuate in case of an emergency.

Laundry area: The laundry area is located adjacent to the kitchen.

Staff Workstation/Office: There is three staff workstations. One located by the kitchen, where the medication cart is stationed. Two are in the living room area where staff and resident files are kept.

Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

Medications: Medication cart is stationed at staff's work station by the kitchen. It was observed locked during the inspection. Medication and Medication Records were reviewed for proper storage and documentation.

Garage: The garage is not attached to the building. It is in the backyard. Garage is used for storage, which was checked and locked. The second story of the garage is the area director's office.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies issued during this annual visit. Exit Interview Conducted / Appeal Rights Discussed / A Copy of the Report Issued.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024
LIC809 (FAS) - (06/04)
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