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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610235
Report Date: 06/21/2024
Date Signed: 06/21/2024 04:01:14 PM

Document Has Been Signed on 06/21/2024 04:01 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:WYSE HOMEFACILITY NUMBER:
197610235
ADMINISTRATOR/
DIRECTOR:
DAVIS, LA QUENCIAFACILITY TYPE:
737
ADDRESS:35158 WYSE ROADTELEPHONE:
(626) 500-1430
CITY:SANTA CLARITASTATE: CAZIP CODE:
91390
CAPACITY: 4CENSUS: 0DATE:
06/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:La Quencia DavisTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Tuesday Cabiness, and Licensing Program Manager Troy Agard conducted an annual inspection. LPA and LPM was greeted by Registered Behavior Technician Patience Kobusingye, who allowed us to enter; there were (3) additional staff on duty. The current census is (2); and during the visit, both clients were at program.

A physical plant tour of the facility inside and outside was conducted with Administrator, LPA and LPM. The following common areas were inspected: living, dining, kitchen, resident bedrooms, and bathrooms.

Kitchen: LPA observed a Licensing requirement of (7) day nonperishable, and (2) perishable. Food was properly wrapped, and appliances were functional, clean, and in good repair. Chemicals, household supplies, and knives, and locked and stored in the garage. Everything was locked and secured. Living/dining: All indoor passageways were free from obstruction; inside temperature was comfortable, with adequate lighting, and all areas were clean and appropriately furnished for resident’s comfort. Bedrooms: The facility has (4) bedrooms. All bedrooms were properly furnished and supplied with appropriate bedding and linens. There were sufficient linens observed and available. Bathrooms: There are (3); all were clean, with soap and towels. Hot water measured at 105.0. degrees Fahrenheit. Surrounding Grounds: There were no visible hazards; passageways were free from obstruction and gates secured. Fire extinguisher fully charged. First aid kit furnished fully equipped. Smoke alarms and carbon monoxide detectors are operating properly.

Record review: A complete record review of staff and client were conducted. All required documents in files; including training was current.

Exit interview conducted, and copy of report provided.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2024
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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