197610288-10-5-2023-31-AS-HRAI-CWBQ5T-20231005115229

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610288
Report Date: 10/05/2023
Date Signed: 10/05/2023 11:53:10 AM

Document Has Been Signed on 10/05/2023 11:53 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	LEMARSH HOME CARE SERVICES, INC.		FACILITY NUMBER:	197610288
ADMINISTRATOR:	TADY, KIMBERLY		FACILITY TYPE:	735
ADDRESS:	21211 LEMARSH ST.		TELEPHONE:	(213) 280-5111
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY: 6		CENSUS: 0	DATE:	10/05/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Katelyn Bautista, Designee		TIME COMPLETED:	12:10 PM

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At 10:00am Licensing Program Analyst (LPAs) Huma Rahimi, Angela Panushkina and Leslie Ngo-Castaneda conducted an unannounced Annual/Required visit. Upon arrival LPAs met with designee, Katelyn Bautista. The purpose of the visit was explained.

Upon entry LAPs did not observe any clients and were informed that the Regional Center (RC) is still in a process of approving this facility's vendorization. At 10:20am, LPAs conducted a physical plant tour with the designee and the following was observed:

Kitchen: At approximately, 10:20am LPAs toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps observed to be locked in a drawer and inaccessible to clients in care. Fire extinguisher in the kitchen was last serviced on 07/19/2023.

Medications: At approximately, 10:25am LPAs observed medications cabinet in the kitchen kept locked.

Bedrooms: There are four (4) bedrooms designated for clients use with sufficient lighting. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Facility will have awake staff.

Bathrooms: At 10:35am LPAs observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPAs observed appropriate grab bar and client's bathroom had non-skid mat. LPAs observed appropriate hand washing signs posted in each bathroom. Hot water temperature measured at 105.9°F.

Common Areas: The facility maintains a comfortable temperature at 77°F. The living room and dining area

Continue on LIC809-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

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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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: LEMARSH HOME CARE SERVICES, INC.	FACILITY NUMBER: 197610288
	VISIT DATE: 10/05/2023

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appeared clean and were properly furnished. The living room has a television, comfortable furniture and the fireplace is adequately screened. No obstructions and or tripping hazards throughout the facility. Laundry is located in the attached garage and will be kept locked and inaccessible to clients in care. LPAs observed all detergents locked and inaccessible to clients in care. Extra PPE supplies and food storage was also observed.

Smoke detectors/carbon monoxide. Smoke detectors were located throughout the facility, and at 10:50am they were tested and observed to be operational. Carbon monoxide was located in a hallway and was also tested and observed to be operational.

Outside areas: At approximately, 11:00am LPAs toured the outside area of the facility. LPAs observed appropriate outdoor furniture, with a covered shaded area for clients. LPAs discussed the importance of maintaining the care and supervision to meet the needs of clients. There are no bodies of water.

Administrative: The Administrator will e-mail LIC.500.

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

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC809 (FAS) - (06/04)

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