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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610249
Report Date: 07/27/2023
Date Signed: 07/27/2023 12:57:51 PM


Document Has Been Signed on 07/27/2023 12:57 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:RAINBOW VILLAGE SENIOR LIVINGFACILITY NUMBER:
197610249
ADMINISTRATOR:ROCK, CAROLFACILITY TYPE:
740
ADDRESS:21746 MAYAN DRIVETELEPHONE:
(213) 712-5100
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY:12CENSUS: 9DATE:
07/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Leslie Borodi, ApplicantTIME COMPLETED:
01:00 PM
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Licensing Program Analysts (LPAs), Angela Panushkina and Melissa Ruiz, arrived at the home and were greeted by the applicant, Leslie Borodi. LPAs conducted an entrance interview with the applicant and applicant granted access to the home.

At 10:15am, LPAs toured the entire home and it appeared to be clean and sanitary and no immediate health and safety issues were observed.

The Applicant informed LPAs that he is still working with the Department of Social Services, Planning, Public Health and Public Works to become licensed for one facility with a capacity of six (6) residents. Applicant stated he is working with all applicable agencies and departments to update the home and requirements needed to get licensed and ensure the safety of all residents. LPAs were informed that the facility is currently on septic, however, the permit for the connection to the main sewer line had been already issued and affidavit signed and within one month it will be completed.

During today’s visit LPAs observed nine (9) residents and LPAs interviewed with nine (9) out of nine (9) residents. Nine (9) out of nine (9) residents are independent and require very minimal supervision. LPAs toured the home and observed sufficient food for all residents with plenty of beverage options, snacks, and meal options. LPAs reminded the Applicant not to take new individuals who need care or supervision in which a license is required. Currently the Application status is pending.

Exit interview was conducted.

Copy of this report signed and issued to the Applicant.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2023
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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