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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610206
Report Date: 12/19/2022
Date Signed: 12/19/2022 01:39:57 PM

Document Has Been Signed on 12/19/2022 01:39 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:STRATHERN HOMEFACILITY NUMBER:
197610206
ADMINISTRATOR:BANOS, SELVAFACILITY TYPE:
735
ADDRESS:11246 STRATHERN STTELEPHONE:
(747) 272-3093
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY: 4CENSUS: 0DATE:
12/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Selva BanosTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) met with Administrator Selva Banos to conduct the annual inspection for the facility. LPA attempted to conduct the inspection on 11/28/2022, but there were was no one at the facility. At this time, the Administrator is currently waiting to admit clients; but was recently informed by Regional Center, the first client will be admitted on 01/01/2023.

Prior to entering the facility, LPA observed COVID signs posted outside the front door and upon entry, LPA was asked COVID screening questions, which entailed temperature check and visitors sign in book. LPA observed the facility to be in it's initial stage during the pre-licensing inspection. There have been no changes, and all common areas were observed to be clean and in good repair.

The facility has (4) bedrooms; with (1) room used for staff, and isolation room if needed for positive COVID cases. Facility has (2) bathrooms. Storage areas, cabinets, pantries, cupboards counters, and refrigerator were clean and appropriate for food preparation. Knives and medication will be stored in cabinets located in the kitchen and hallway area. Appliances were clean and functional, and utensils, plates, and cups were in good repair. Cleaning supplies, poisons, toxins and chemicals will also be locked and stored in a cabinet located in the hallway. There was enough supply of linens and towels, which were stored individually in the client bedrooms. Hygiene products are available.

The common areas included the dining, living, bathroom, and client bedrooms. Doors and passageways were clear and unobstructed. Walls, ceilings, floors, window screens and all other rooms were clean, in good repair, and appropriately furnished.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 11/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/28/2022
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: STRATHERN HOME
FACILITY NUMBER: 197610206
VISIT DATE: 12/19/2022
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Client rooms were in good repair. Bathrooms were clean had functional fixtures, with soap and towels and grab bars. The back yard is completely fenced with a gate easily accessible and unlocked. No other visible hazards around the surrounding grounds.

Garage area was locked and secured with extra refrigerator, and laundry equipment. Staff and client files are stored in a locked cabinet.

Administrator reported to LPA that she will be changing the Administrator for the facility. Documents were submitted to LPA, who will review and make the changes. Also, Administrator reported that the first client that will be admitted on 01/01/2023, is not currently vaccinated, but has agreed to complete the shots. All staff that are hired to work, are vaccinated and have received booster shots. There is an isolation room with bathroom that could be used for COVID purposes. New staff hires must be vaccinated. Administrator continues to receive departmental emails and participates in the surveys that are sent.

PPE, chemicals, cleaning supplies, personal hygiene supplies, and paper products are stored in a locked closet and garage area. The facility has been COVID-19 free.

cAdministrator informed LPA that she will ontinue to implement the best practices for their facility. The facility is aware to report any changes with clients and staff to Licensing and there LPA, pertaining to positive COVID-19 cases.

Exit interview and copy of report provided.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022
LIC809 (FAS) - (06/04)
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