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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610288
Report Date: 09/24/2024
Date Signed: 09/24/2024 12:08:51 PM

Document Has Been Signed on 09/24/2024 12:08 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:LEMARSH HOME CARE SERVICES, INC.FACILITY NUMBER:
197610288
ADMINISTRATOR/
DIRECTOR:		TADY, KIMBERLYFACILITY TYPE:
735
ADDRESS:21211 LEMARSH ST.TELEPHONE:
(213) 280-5111
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY: 4CENSUS: 0DATE:
09/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Katelyn Bautista, DesigneeTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
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At 11:30am Licensing Program Analyst (LPAs) Angela Panushkina and Huma Rahimi conducted an unannounced Annual visit. Upon arrival LPAs met with designee, Katelyn Bautista and explained the reason for the visit.

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 vendor number. At 11:35am, LPAs conducted a physical plant tour with the designee and the following was observed:

Kitchen: 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 kitchen cabinet and inaccessible to clients in care. Fire extinguisher in the kitchen was last serviced on 08/09/24.

Medications: Medications will be stored in a kitchen cabinet and at 11:40am, LPAs observed the cabinet 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 11:55am 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 108.9°F.

Continue on LIC809-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
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: 09/24/2024
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Common Areas: The facility maintains a comfortable temperature at 77°F. The living room and dining area 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. At 12:00pm, LPAs observed all detergents locked and inaccessible to clients in care. Extra supplies and food storage was also observed.


Smoke detectors/carbon monoxide. Smoke detectors were located throughout the facility, and at 12:15pm 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, 12:20pm 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.


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

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
LIC809 (FAS) - (06/04)
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