197610135-3-14-2024-31-AS-MCAA-D3CSXC-20240314141543

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610135
Report Date: 03/14/2024
Date Signed: 03/14/2024 02:16:20 PM

Document Has Been Signed on 03/14/2024 02:16 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 - GRANADA HILLS		FACILITY NUMBER:	197610135
ADMINISTRATOR:	FREEMAN, ELIZABETH		FACILITY TYPE:	735
ADDRESS:	16544 BIRCHER AVE		TELEPHONE:	(818) 269-1402
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY: 4		CENSUS: 2	DATE:	03/14/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:49 AM
MET WITH:	Adeleye Sotimehin, Flavia Nampiima		TIME COMPLETED:	02:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	In conjunction with a Case Management (CM) visit, Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the back up administrator, Adeleye Sotimehin and Direct Support Professional (DSP), Flavia Nampiima and explained the reason for the visit. Quality Improvement Specialist (QIS) Kenda Comstock, was notified over the telephone. At approximately 10:49am, with the assistance of the administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are hardwired and interconnected. The carbon monoxide detector is installed in the living room. It is functional. The fire extinguisher is located near the kitchen. The charge date is 06/22/23. The last earthquake drill was conducted on 02/15/24 and fire drill on 02/27/24. This is a specialized Adult Residential Facility (ARF), licensed to serve clients age 18-59. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. The kitchen was observed to be clean and sanitary. Knives are kept in a lock box, locked in a closet where staff and resident records are kept. No cleaning supplies were observed present and accessible to the residents in care. Bedrooms: There were four (4) bedrooms designated for residents' use. All four bedrooms are for private use. Three (3) of the four (4) bedrooms were inspected and were observed to by properly furnished with appropriate beddings and linens with sufficient lighting. LPA was not granted access to inspect Resident 2's (R2) room at the time of the visit. R2 wanted privacy. Bathrooms: There are two (2) bathrooms designated for residents' use. Both bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 109 degrees Fahrenheit. No cleaning supplies or medications were stored or kept in the client's bathroom during today's visit.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: REM CALIFORNIA LLC - GRANADA HILLS	FACILITY NUMBER: 197610135
	VISIT DATE: 03/14/2024

NARRATIVE

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Common Areas: These included the living room, family room and dining area. The common areas were properly furnished. The furniture was observed to be in good repair, and the floors were clean. The dining room table was large enough to seat up to six (6) individuals. The auditory alarms at all exit doors were functional at the time of the visit.

Staff Work Station: There is a staff workstation at the corner of the family room, by the backyard exit. Medication cart is kept there. It was observed locked during the inspection.

Surrounding Grounds: Entry/exits were free of obstruction. There is backyard furniture appropriate for outdoor use. The outdoor area, front and back was free of hazards. The laundry area is located in the family room. No detergents are kept there. Cleaning supplies and detergents are kept locked in a kitchen cabinet.

Resident Files: Resident files are stored locked in a closet in the family room. LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: Staff files are also kept locked in the same closet as the resident files. LPA conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

Medications: Medication and Medication Records were reviewed for proper documentation. The medication cart is located by the staff work station in the family room. The cart was observed to be locked.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of this Report Issued.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

LIC809 (FAS) - (06/04)

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