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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610137
Report Date: 03/15/2021
Date Signed: 03/15/2021 05:43:57 PM

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 - OSBORNEFACILITY NUMBER:
197610137
ADMINISTRATOR:WINKEY, JEANNETTEFACILITY TYPE:
735
ADDRESS:15952 OSBORNE ST.TELEPHONE:
(818) 893-1234
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:4CENSUS: 3DATE:
03/15/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Idris DanesiTIME COMPLETED:
04:07 PM
NARRATIVE
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Licensing Program Analyst (LPA) Martina Berry met with Regional Program Manager Idris Danesi at 2:30 PM. Due to the situation surrounding Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, this visit was conducted virtually. The LPA met with Area Director, Idris Danesi and explained the reason for the visit.

On Friday, March 12th, the LPA became aware that the facility telephone was out of order. The LPA spoke with Area Director, Idris Danesi, to discuss the issue and obtain an alternate phone number for the facility. The LPA spoke with facility staff on the same day, who informed the LPA that the facility phone had been out of service since Thursday, March 11th. Staff (S1) informed the LPA that the facility telephone would be serviced on March 12th, 2021. The LPA attempted to contact the facility using the facility phone number on Monday, March 15th, 2021, however the phone was still out of service. The LPA contacted Area Director, Idris Danesi, regarding this issue and he informed the LPA that the facility is still working to resolve this issue. Per Title 22 regulations, the facility must always have a working phone.

Deficiencies cited. The LPA met with the Area Director to conduct an exit interview and complete a plan of action to resolve the issue. A copy of this report was provided via email for signature.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (8185964342
LICENSING EVALUATOR NAME: Martina BerryTELEPHONE: (661) 361-6007
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2021
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 - OSBORNE
FACILITY NUMBER: 197610137
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/16/2021
Section Cited

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(a) All facilities shall have telephone service on the premises.

This requirement has not been met as evidenced by: LPA observation. Staff did not ensure that telephone service was provided on the premises.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (8185964342
LICENSING EVALUATOR NAME: Martina BerryTELEPHONE: (661) 361-6007
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2021
LIC809 (FAS) - (06/04)
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