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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610328
Report Date: 04/27/2023
Date Signed: 11/21/2023 01:37:35 PM

Document Has Been Signed on 11/21/2023 01:37 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:LIFESYNC MALIBUFACILITY NUMBER:
197610328
ADMINISTRATOR:OHOP, RYELYFACILITY TYPE:
772
ADDRESS:5795 CALPINE DRIVETELEPHONE:
(310) 951-6340
CITY:MALIBUSTATE: CAZIP CODE:
90265
CAPACITY: 6CENSUS: 0DATE:
04/27/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ryely Ohop, Administrator TIME COMPLETED:
11:45 AM
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Licensing Program Analysts (LPAs) Mariana Agban and Angela Panushkina conducted a Pre-Licensing Inspection with Program Directors/Administrators Michael Bradshaw and Ryely Ohop. An Application to operate a Social Rehabilitation Facility, Short-Term Crisis Residential Treatment Program was received by Community Care Licensing (CCL) on 07/21/22. A fire clearance was approved on 09/16/22 for a maximum capacity of six (6) ambulatory adults.

A tour of the physical plant was initiated at 10:10am and the following was observed:

KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven and sink. There were adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). Fire Extinguisher was last serviced on 12/20/22.

BEDROOMS: There are four (4) bedrooms designated for client use. Two bedrooms will be designated for shared rooms and the other two bedrooms are private. All bedrooms are furnished with beds, dressers and required bedding and linen. The bedrooms have sufficient closet space.

BATHROOMS: Each client bedroom has its own bathroom. The bathroom in bedroom #4 is the only client bathroom equipped with a bathtub. It will be made available for clients in that room to utilize. In addition to the four (4) bathrooms located in each client room, facility has one and half (1½ ) additional community bathrooms that are available for client use. The hot water delivered in the client bathrooms measured at 105.1°F

COMMON AREAS: The facility maintains a comfortable temperature at 68°F. These included a living room furniture, a television, tables and chairs and a dining area. The Common areas are furnished with adequate
Continue on LIC809-C
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LIFESYNC MALIBU
FACILITY NUMBER: 197610328
VISIT DATE: 04/27/2023
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furniture to accommodate a maximum capacity of six. There were no visible immediate hazards.

LAUNDRY ROOM: The laundry room is located upstairs. The washer/dryer appear to be in good condition. Laundry supplies are kept inaccessible when not in use with supervision.

MEDICATION ROOM: The medication will be kept in a locked cabinet located upstairs in a staff office.

OFFICE, STAFF AND THERAPY/TREATMENT AREAS, GUEST ROOM: There are multiple office spaces and a guest room that will be used for administrative duties and individual therapy. Group Therapy will be conducted in the common areas.

SURROUNDING GROUNDS: The entrance to the home is gated and requires for guest to be announced. The driveway serves as a large parking lot for guests. In the back of the facility has sufficient yard space. LPAs observed appropriate outdoor furniture, with a covered shaded area for clients. There is a swimming pool that is fenced all around with a gate that will be kept locked at all times. The fence surrounding the swimming pool is approximately 5 feet high all around. You will need a key to gain entry to the swimming pool as it is kept locked at all times. LPAs discussed the importance of maintaining the care and supervision to meet the needs of clients.

Pursuant to Title 22, Division 6 Chapter 2, the facility's physical environment appears to be compliant and ready for licensure. CAB will be advised and a copy of this report provided.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
LIC809 (FAS) - (06/04)
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