197610237-2-29-2024-31-AS-LCAS-D2WSXZ-20240229131646

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610237
Report Date: 02/29/2024
Date Signed: 02/29/2024 01:17:00 PM

Document Has Been Signed on 02/29/2024 01:17 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:	ABAD CARE HOMES		FACILITY NUMBER:	197610237
ADMINISTRATOR:	OLIVAS, MYLINE		FACILITY TYPE:	740
ADDRESS:	20128 DEVONSHIRE ST		TELEPHONE:	(747) 237-0417
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY:	6	CENSUS: 5	DATE:	02/29/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Myline Olivas		TIME COMPLETED:	01:30 PM

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Licensing Program Analyst (LPA), Lorena Casillas, met with Myline Olivas for an unannounced one (1) year Required visit for this facility.

At 10:15 am LPA arrived at the facility and was granted access by a Caregiver who then called the Administrator. The administrator arrived shortly after, and LPA explained the reason for the visit.

Fire clearance was granted for a total of six (6) residents of which five (5) are non-ambulatory and (1) bedridden. LPA observed that currently there are five (5) residents in care, two (2) of which are under hospice care.

At 11:10 am, LPA conducted a tour of the facility, and the following was observed:

Infection control: LPA reviewed facility infection control plan submitted on 01/13/2022 to make sure licensee was following current infection control recommendations.

Kitchen: At 11:10 am LPA toured the kitchen area and observed enough supplies of non-perishables for seven (7) days and perishables for two (2) days at the facility. All knives and medications are observed to be locked in a kitchen cabinet and in a locked side cabinet inaccessible to residents. There is a fire extinguisher in the kitchen area, and it was last serviced on 07/17/2023.

Bedrooms: There are four (4) bedrooms designated for resident use and have sufficient lighting. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Auditory alarms were tested and observed to be operational. Facility has awake staff at night.

Continued on LIC809-C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena Casillas	TELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:	DATE: 02/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024

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: ABAD CARE HOMES	FACILITY NUMBER: 197610237
	VISIT DATE: 02/29/2024

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Bathrooms: LPA observed two (2) bathrooms that are clean and in good repair. Properly supplied with toilet paper, soap, and paper towels. The hot water temperature measured 116.2 °F. LPA observed appropriate grab bars and non-skid mats. LPA observed appropriate hand washing signs posted in each bathroom. All trash cans in bathrooms had fitted lids to protect from cross contamination.

Common Areas: The facility maintains a comfortable temperature at 69 °F. The living room and dining area appeared clean and were properly furnished. No obstructions or tripping hazards throughout the facility. LPA observed all trash cans throughout the facility have fitted lids. Smoke and carbon monoxide detectors were located throughout the facility, and at 11:40 am they were tested and observed to be operational.

Outside Areas: LPA toured the outside area of the facility. LPA also observed a clean covered patio and backyard furniture. There were no bodies of water observed. There are two (2) sheds located in the backyard used for storage. LPA was granted access and observed that sheds are used for storage.

Laundry/Garage: Laundry area is in the garage and LPA observed it to be locked and inaccessible to residents in care. LPA observed an attached locked garage door inaccessible to residents. Extra PPE supplies and food storage were also observed.

Resident Files: LPA conducted a file review of resident records to ensure compliance of licensing forms.

Staff Files: LPA conducted a file review of staff records to ensure compliance of licensing forms.

Medications: LPA and Administrator reviewed medication and medication records for proper documentation.

Staff Interviews: At 12:15 pm LPA interviewed staff. Client Interviews: At 12:45 pm LPA interviewed clients.

Administrative: Annual fees are current. LPA collected Certificate of Liability Insurance, LIC500, Administrator Certificate and Resident Roster.

No citations issued during this visit. Exit interview conducted. Copy of report given to the Administrator.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena Casillas	TELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:	DATE: 02/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024

LIC809 (FAS) - (06/04)

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