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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610285
Report Date: 03/25/2024
Date Signed: 03/25/2024 12:21:34 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/25/2024 12:21 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:AKHILE ASSURANCE ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
197610285
ADMINISTRATOR:AKHILE, MYCOLFACILITY TYPE:
735
ADDRESS:43712 OLEANDER STREETTELEPHONE:
(714) 902-3571
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: 0DATE:
03/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Mycol AkhileTIME COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA) Lorena Casillas met Administrator Mycol Akhile for an unannounced one (1) year Required visit for this facility.

LPA arrived at 09:45 am and was greeted by Administrator. LPA informed the Administrator of the purpose of the visit and entry was granted.

A tour of the physical plant was conducted with the Administrator at 9:47 am. The facility has three (3) bedrooms and two (2) bathrooms currently unoccupied. Three (3) bedrooms are for resident use and one (1) bedroom is used for staff. The facility is Fire Cleared for four (4) ambulatory.

The facility does not currently have any residents, therefore the Inspection Tool Kit will not be used for this visit.

Food Inspection: LPA conducted a tour of the kitchen at 9:55 am and observed there to be sufficient stock of two-day perishables and seven-day non-perishables foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas care clean and inaccessible to pests. LPA observed all knives and sharp objects locked in a kitchen drawer. Medication will be stored in a locked cabinet located in the kitchen and inaccessible to residents in care. There is one (1) fire extinguisher located in the kitchen and one (1) located in the garage. The fire extinguishers were purchased today, and receipt was provided.

Resident Rooms: LPA observed rooms to have the appropriate bedding. There is a nightstand, chair, and sufficient lighting for each resident.

Continued on LIC809-C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 03/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/25/2024
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: AKHILE ASSURANCE ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 197610285
VISIT DATE: 03/25/2024
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Bathrooms: At 10:00 am LPA observed all bathrooms to have the appropriate wash your hands signs posted. Hot water was tested at 10:00 am and measured within regulation at 117.7 degrees F.

Garage/Laundry: At 10:10 am, LPA observed chemicals/hazardous items in a locked in the garage. LPA observed the garage to be attached to the facility and currently being used for extra storage.

Physical environment: LPA toured the outside area of the facility at 10:20 am. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. No bodies of water on the premises.

Living and dining: LPA observed the living room to be neat and clean along with the dining room. The facility maintains a comfortable temperature at 72°F. The smoke detectors and carbon monoxide detectors were tested and observed to be operational at 11:00 am.

Administrative: Annual fee is current. Renewal of Administrator Certificate is on file and copy of Bond will be emailed to LPA.

Interviews Staff/Clients: There are currently no clients or staff.

No citations issued. An exit interview was conducted, and a copy of this report was given to the Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024
LIC809 (FAS) - (06/04)
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