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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610149
Report Date: 03/26/2021
Date Signed: 03/26/2021 03:25:18 PM

Document Has Been Signed on 03/26/2021 03:25 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:HOME CARE OF WEST HILLS #1 LLCFACILITY NUMBER:
197610149
ADMINISTRATOR:HILADO, STEPHANIE L.FACILITY TYPE:
740
ADDRESS:22454 SCHOOLCRAFT STREETTELEPHONE:
(818) 610-7276
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY: 6CENSUS: 6DATE:
03/26/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Stephanie HiladoTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Yelena Avetisyan conducted an announced Pre-Licensing visit due to change of ownership. Due to the situation surrounding Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, this visit was conducted virtually via Zoom with administrator.

The LPA conducted a virtual facility tour. This is a single story home. The facility has 4 bedrooms and 2 bathrooms. Bathrooms are shared between clients and staff. Each room is equipped with closet space, storage drawers, night stand, bedding, and lighting that meet Title 22 Regulations. Bathrooms are clean and in good repair with required grab bars and nonskid mats. Bathrooms have sufficient soap and paper towels. The facility has a sufficient supply of linen and toiletries for client use.

Common areas provided sufficient seating and lighting for resident use. Board games, cards, books, and puzzles are available for client use in the common areas. The kitchen is clean; fixtures and appliances are in good repair. Cleaning products, sharps, and other toxic substances are kept in locked cabinets, inaccessible to residents. There is a sufficient supply of perishable & non-perishable foods. The kitchen is stocked with dishes, eating utensils, pots and pans. There is a dining area with table and seating.

Smoke detectors are hard wired throughout the facility. Medications, resident and staff records, are kept in locked cabinets. The first aid kit has all required supplies. The backyard has seating with shaded and unshaded areas. There is space for clients to engage in outdoor activities. The laundry area was clean and appliances were in good repair. There are sufficient laundry supplies, which are kept locked and inaccessible to clients.

The LPA observed that all areas in the facility met Title 22 Regulations. No additional items are needed prior to license approval. An exit interview was conducted with Administrator. A copy of this report was provided via email for signature.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Yelena Avetisyan
LICENSING EVALUATOR SIGNATURE: DATE: 03/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2021
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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