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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610288
Report Date: 10/13/2022
Date Signed: 10/13/2022 11:42:50 AM

Document Has Been Signed on 10/13/2022 11:42 AM - 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:LEMARSH HOME CARE SERVICES, INC.FACILITY NUMBER:
197610288
ADMINISTRATOR:TADY, KIMBERLYFACILITY TYPE:
735
ADDRESS:21211 LEMARSH ST.TELEPHONE:
(213) 280-5111
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY: 6CENSUS: 0DATE:
10/13/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kimberly Tady TIME COMPLETED:
11:55 AM
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On 10/13/22 Licensing Program Analyst (LPA) Joscelyn Martinez arrived at the facility to conduct an announced Pre-licensing Inspection. Upon arrival LPA met with Administrator Kimberly Tady. This is an application for Adult Residential Facility and has been approved for a total capacity of six (6) clients. Fire clearance has approved bedrooms three (3) and four (4) for non-ambulatory clients. The facility is a single-story home with four (4) bedrooms and two (2) bathrooms.

Common Area: LPA observed the living room and furniture to be clean and in good repair. Living area has a fireplace with appropriate covering. The facility maintains a comfortable temperature of 69 degrees F and has a functional air conditioner. No firearms observed or will be maintained on the premises. The smoke alarm and carbon monoxide detector were operational and tested at 10:42 a.m. The fire extinguisher was observed to be with a full charge and with a purchase date of 05/10/22. Facility will always maintain a cellphone and a land line in the facility for clients use

Kitchen/Dinning Area: LPA observed the kitchen area to be in good repair and sanitary. LPA observed a startup fully of food as well as emergency food. Sharps and medications were observed to be locked and inaccessible to residents. Trash can contain a tight-fitting lid. Appropriate plates and cups were observed. No chemicals will be stored in the kitchen area. LPA observed the dining area to be clean and in good repair. Activities were observed in the dining room area. First aid kit was observed with all the appropriate requirements.

Bedrooms: Facility has four (4) bedrooms of which all will be used for clients. Bedroom three (3) and four (4) are shared and bedroom one (1) and two (2) will be for single use. All bedrooms were toured and observed with appropriate furniture and bedding. Thrash cans in bedrooms all contained tight fitting lids to prevent cross contamination.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Joscelyn Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LEMARSH HOME CARE SERVICES, INC.
FACILITY NUMBER: 197610288
VISIT DATE: 10/13/2022
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Bathrooms: Facility has two (2) bathrooms designated for client’s use. Bathrooms were toured and were observed to have trash cans with tight fitting lids. Hot water was tested and measured at 117 degrees F. LPA observed sufficient towels and wash cloths for clients .

Garage: Facility has a garage that is accessible through the dinning area. Garage will be used for storage and laundry area. Chemicals will be kept locked in the garage.

Outside: LPA observed appropriate outdoor furniture with a shaded area for clients. There is a shed that will be used for additional storage. This shed will be kept locked and inaccessible to clients. There are no bodies of water.

Pre-Licensing Self-Certification checklist was discussed with administrator. LPA discussed preplacement staffing, training, customer service, inspection authority, reporting requirements (mandated reporter), records, citations, criminal record clearance, civil penalties, labor law, activities, expectation is to follow all rules and regulations. No deficiencies were observed.

Once component III is completed, this report will be sent to Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when the license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Joscelyn Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022
LIC809 (FAS) - (06/04)
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