197610341-5-26-2023-31-AS-LQLY-CS7SSU-20230526140830

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610341
Report Date: 05/26/2023
Date Signed: 05/26/2023 02:08:39 PM

Document Has Been Signed on 05/26/2023 02:08 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:	CORAZON RESIDENTIAL		FACILITY NUMBER:	197610341
ADMINISTRATOR:	SALVADOR, CHRIS		FACILITY TYPE:	735
ADDRESS:	7358 MAYNARD AVE		TELEPHONE:	(818) 455-3007
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91307
CAPACITY: 4		CENSUS: 0	DATE:	05/26/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Licensee Chris Salvador & Administrator Jhomer Yuson		TIME COMPLETED:	02:15 PM

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Licensing Program Analyst (LPA) LaQueena Lacy arrived at the facility on 05/26/2023 at 10:35AM to conduct an announced Pre-Licensing visit and met with Licensee (LE) Chris Salvador and Administrator (AD) Jhomer Yuson. Entrance Interview conducted with both parties and explained the purpose of today’s visit, is to inspect the facility and ensure compliance with rules and regulations California Code of Regulations, Title 22, Division 6.

Today's site visit consisted of the LPA, LE and AD touring the physical plant at 10:47AM inside and outside the following was observed: The facility has one main entrance being used. The facility is a four-bedroom, two (02) bath single-story building with an attached garage. The facility fire clearance is granted for four (04) non-ambulatory residents. The facility temperature observed to be in range of 75 degrees Fahrenheit(F).

Kitchen: At 10:50AM LPA observed the kitchen to be clean and free from obstruction. Appliances observed

to be in good repair and functional. Sharps were observed to be locked and stored inaccessible to residents in a cabinet on the right of the kitchen sink. Refrigerated and frozen foods were stored at proper temperatures with sufficient amount of perishable and non-perishable foods were properly stored. At 10:54AM LPA observed a pantry storing dry food, canned goods and the emergency food supply lunch/dinner 96 servings and ready plus breakfast 56 servings. At 10:56AM, LPA observed toxins and cleaning supplies locked and inaccessible to resident underneath the kitchen sink. The first aid kit and manual stored in a kitchen cabinet.

Medications: At 10:58AM the medication cabinet was observed to be locked and inaccessible to residents clean and free from debris or obstruction.

Bedrooms: At 11:04AM LPA inspected (04) bedrooms all were observed to be clean and appropriately furnished and equipped with adequate lighting and bedroom furniture. Exit doors observed to have an auditory alarms which were tested and observed to be operational and functioning. Extra towels and linens will be stored in cub boards in the bedrooms.

Continued on LIC812.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: LaQueena Lacy
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: CORAZON RESIDENTIAL	FACILITY NUMBER: 197610341
	VISIT DATE: 05/26/2023

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The Eufy Security auditory alarm notification system is in the living room, observed to be operational and functioning, LPA observed the alarm to chime when an exit door was opened in the home. Screen doors and window coverings observed during the time inspection. Bedroom #1 has a fireplace observed to be locked with a combination lock and inaccessible to residents.

Bathroom: At 11:16AM LPA observed (02) bathrooms to have non-skid mats and appropriate grab bars installed in the shower and around toilet. At 2:08PM hot water was tested in bathrooms and measured in range of 108.3-115.1 degrees F.) The telephone on premises is operational and functioning. The emergency exit plan/sketch is posted on the wall in the hallway and living/dining room area.

Laundry Room, dining room and common areas: At 11:24AM, LPA observed the outside and surrounding area of the facility to be clean and clear from debris and obstruction. The back of the facility has a table, chairs, and a bench for lounging under a covered patio area that’s enclosed with a gated fence. No bodies of water observed on the property. At 11:35AM the attached garage was observed to be locked and inaccessible to resident, to be storing constructions supplies, personal items, and furniture. The facility has a storage cabinet in the hallway observed to be locked and storing activities, extra linen, and decorations. At 11:38AM the common areas (living room, dining areas) were observed to appropriately furnished and lighting is adequate and comfortable furniture for seating which was observed to be in good repair. The Kiddie fire extinguisher is located in the kitchen and was purchased on 05/26/2023 from Home Depot. The facility has a fire extinguisher that was inspected by fire inspector but did not display a service tag. The facility has plug in night lights around the facility that also double as emergency/flash lights in case of an emergency. At 11:38AM the facility carbon monoxide detector and fire detector alarms (interconnected) were tested and observed to be operational and functioning properly.

Component III was conducted with the LE and AD at 1:15PM. The Facility is currently in compliance with Title 22 Regulations at the time of the visit. This report will be forwarded to the Centralized Application Bureau (CAB).

Exit interview was conducted with LE and AD, and a copy of this report was provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: LaQueena Lacy
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

LIC809 (FAS) - (06/04)

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