197610206-12-11-2023-31-AS-CALH-CYF2T4-20231211164006

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610206
Report Date: 12/11/2023
Date Signed: 12/11/2023 04:41:45 PM

Document Has Been Signed on 12/11/2023 04:41 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	STRATHERN HOME		FACILITY NUMBER:	197610206
ADMINISTRATOR:	BANOS, SELVA		FACILITY TYPE:	735
ADDRESS:	11246 STRATHERN ST		TELEPHONE:	(747) 272-3093
CITY:	SUN VALLEY	STATE: CA	ZIP CODE:	91352
CAPACITY: 4		CENSUS: 3	DATE:	12/11/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Selva Banos		TIME COMPLETED:	04:40 PM

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On 11/6/23 at around 9:25 AM, Licensing Program Analyst (LPA) Christopher Alemoh conducted an unannounced Required – 1 Year Inspection at Strathern Home and met with staff (S1) Administrator Selva Banos. LPA explained the purpose of the visit and were accompanied by S1 inside and outside the facility during this inspection.

Facility temp measured at 71 degrees The facility consists of 3 client bedrooms, 1 staff bedroom, 1 bathroom, a living room, dining room, laundry room and kitchen.

This facility is licensed to serve 4 adults ages 18 – 59 years. A total of 3 clients are currently residing in this facility, 3 out of 3 clients are ambulatory. A total of 2 staff and one client were present during this inspection.

At 02:10PM LPA conducted physical plant tour.

Outside grounds were toured and no bodies of water were observed. Patio furniture under a shaded area was accessible to clients. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. LPA observed security cameras backyard and in front yard.

3 out of 3 client’s bedrooms were checked. Mattresses were in good condition, adequate lighting, plenty of dresser and closet space observed. Walls and floors were clean and in good condition. Comforters, bed linen, bath towels and mattress protectors were adequately stocked. Bathroom toilets and water faucets worked properly. Adequate lighting and toiletries accessible to clients. LPA Alemoh tested hot water temperature in the middle hallway client restroom, and it measured 116 degrees Fahrenheit. All restrooms have proper hand washing signs. This facility provides clients with residents with hygiene products such as feminine napkins, nonmedicated soap, toilet paper, toothbrush, toothpaste, and comb.

LPA observed supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Located in the pantry.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Christopher Alemoh
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023

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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: STRATHERN HOME	FACILITY NUMBER: 197610206
	VISIT DATE: 12/11/2023

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LPA observed laundry room in the garage both appliances were clean and functional. Chemicals and toxins were locked and inaccessible inside of black cabinet. Facility has an extra fridge and freezer in the garage that staff/residents.

LPA observed that Medications were safe, locked and inaccessible. All medications observed were labeled and maintained in compliance with label instructions and State and Federal law. All Medication and knives are stored in a cabinet adjacent to the kitchen. Documents are posted as mandated. Last Disaster drill was conducted June 12^th 2023. First aid kit is fully stocked with manual. Smoke and carbon monoxide detectors are hardwired and in compliance and operational. Two (2) Fire Extinguishers were observed throughout the facility purchase date is May 5th, 2023.

At 02:45 PM LPA conducted a File Review.

Five (5) staff records were reviewed, 5 out of 5 staff records had current first aid certificates and had required criminal record clearances or criminal record exemptions. Five (5) client records were reviewed and, 5 out of 5 client records had Admission Agreements, Medical Assessments, Pre-appraisals (or Reappraisals) and/or Needs & Services Plans. LPA Alemoh reviewed P&I money, 5 out of 5 residents P&I were intact and were not commingled with facility funds or petty cash. All client/resident and staff files are locked and secured in hallway closet.

No deficiencies cited

An exit interview was conducted. A copy of this report and appeal rights were discussed and left with Administrator Selva Banos.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Christopher Alemoh
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023

LIC809 (FAS) - (06/04)

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