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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610206
Report Date: 12/04/2024
Date Signed: 12/05/2024 11:06:06 PM

Document Has Been Signed on 12/05/2024 11:06 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 HOMEFACILITY NUMBER:
197610206
ADMINISTRATOR/
DIRECTOR:		BANOS, SELVAFACILITY TYPE:
735
ADDRESS:11246 STRATHERN STTELEPHONE:
(747) 272-3093
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY: 4CENSUS: 4DATE:
12/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:22 AM
MET WITH:Selva Banos, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 12/04/2024 11:00AM Licensing Program Analyst (LPA) de la Cerra arrived at the facility listed above to conduct an unannounced annual inspection. LPA was greeted by caregiver, Svetlana. Administrator was contacted and arrived soon after. LPA explained to the administrator the reason for the visit.
This home is designed to operate as a Level 2 Adult Residential Facility (ARF), this facility's fire clearance was approved on 8/13/2021 for four (4) ambulatory developmentally disabled clients.
At approximately 11:30am LPA and the administrator toured the facility, and the following was observed. The facility is a single-story building with an attached garage.The facility maintains a comfortable temperature at 72°F. LPA observed two (2) fire extinguishers, both fully charged and inspected on 5/11/2024. LPA observed the required facility postings by the entrance hallway. The facility provides a telephone for clients to use and LPA observed the phone to be operational.
LPA observed dual smoke/carbon monoxide detectors that are hard wired and interconnected. Smoke detector was tested and was observed to function properly.

Kitchen Area: The main area kitchen where clients’ meals are prepared was observed to be clean. Appliances were clean and functional. LPA observed a sufficient amount of 2-day perishable and 7-day non-perishable supply of food and were properly stored. LPA observed knives kept in a locked cabinet, inaccessible to clients. Trash bin has a covered lid. The dining table by the kitchen area had the appropriate table and chairs to accommodate the clients at this facility.

Common Areas: The facility has two(2)separate seating areas available for client use. Both areas rooms clean and properly furnished. No obstructions and or tripping hazards throughout the common area.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: STRATHERN HOME
FACILITY NUMBER: 197610206
VISIT DATE: 12/04/2024
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Bedrooms: There are four (4) bedrooms designated for client use. All bedrooms are furnished with a night stand, a chair, a lamp, a chest of drawers, a closet and a bed with clean bedding and linens. All bedrooms have sufficient closet space and have sufficient lighting.
Bathrooms: LPA observed two (2) bathrooms that are clean and in good repair. LPA observed the functional and appropriate fixtures. Properly supplied with toilet papers, soap and paper towels. The hot water temperature measured between 110°- 118°F. LPA observed the appropriate grab bars by the toilet and in the shower areas. LPA also observed non-skid mats in the shower area.
Garage/Laundry Area: LPA observed the garage is accessible by a door from the living room area. The garage is used to store a functioning refrigerator that stores additional food supply. LPA also observed the washer and dryer in the garage which appears to be in good condition. LPA also observed a locked cabinet that stores laundry detergents and some cleaning solutions,
Surrounding grounds: No bodies of water was observed. LPA observed the backyard free from obstructions. A seating area with shade was available for clients to use. LPA observed a locked shed which is inaccessible to clients and it is used as an additional storage for supplies and clients' personal items.
Facility Records: At 1:30PM LPA conducted review of clients’ records and staff records.
LPA reviewed four (4) out four (4) client records and three (3) staff records were reviewed to ensure compliance. The facility files were kept in locked cabinet in the bedroom hallway.
Medications: The medications were kept in locked cabinet in the bedroom hallway and is inaccessible to clients in care. The first-aid kit is complete.
At approximately 2:15PM medications and medication records were reviewed for proper documentation. Centrally Stored Medication Records are pre-filled by pharmacy and facility keeps a Medication Administration Record (MAR).
Administrative: LPA collected a copy of Certificate of Liability Insurance effective until 06/09/25, copy of Surety Bond effective until 5/29/2025, LIC500 and LIC9020.

No deficiencies cited during today's visit. Exit interview conducted and copy of this report signed and delivered.




SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
LIC809 (FAS) - (06/04)
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