197610376-6-15-2023-31-AS-APAA-CSTQJ6-20230615121214

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610376
Report Date: 06/15/2023
Date Signed: 06/15/2023 12:12:56 PM

Document Has Been Signed on 06/15/2023 12:12 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:	LIFESYNC MALIBU		FACILITY NUMBER:	197610376
ADMINISTRATOR:	O'HOP, RYELY		FACILITY TYPE:	772
ADDRESS:	6231 MURPHY WAY		TELEPHONE:	(310) 951-6340
CITY:	MALIBU	STATE: CA	ZIP CODE:	90265
CAPACITY: 6		CENSUS: 0	DATE:	06/15/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Ryely O'hop, Administrator		TIME COMPLETED:	12:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Angela Panushkina conducted an announced Pre-Licensing visit to this facility and met with the Administrator, Ryely O'hop,. This is an initial application to operate a Social Rehabilitation Facility (SRF). The applicant is LIFESYNC RECOVERY AND DETOXIFICATION LLC. The Fire Clearance was received by the Department on March 16^th, 2023. Clearance granted for ambulatory only on March 2^nd, 2023. Purpose of today’s visit is to inspect the facility to ensure that it is in compliance with the rules and regulations of California Code of Regulations, Title 22. Facility is a two storey home. Today's site visit consisted of LPA touring the physical plant inside and outside and observed the following: The facility has dual smoke/carbon monoxide alarm system. It is hard wired and interconnected. The fire extinguishers located in the kitchen and throughout the hallway and common areas of the facility and was last serviced on 12/22/2022. Dual Smoke and Carbon Monoxide detectors were observed all over the facility. There is a functioning telephone on the premises. There are four (4) resident bedrooms. Two (2) rooms are private, and the other two (2) rooms are shared. Resident bedrooms were observed to be appropriately furnished with adequate lighting. Passageways to enter and exit each rooms were clear of any obstruction. The common areas (living room, kitchen and dining areas) were appropriately furnished, and lighting was adequate. The living room area has plenty of space with a comfortable furniture. There are five (5) bathrooms in the facility. Non-skid material in place. The master bathroom has a bathtub, which would be optional for client use. Continued on LIC 809-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

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: LIFESYNC MALIBU	FACILITY NUMBER: 197610376
	VISIT DATE: 06/15/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Clients prescribed and over-the-counter medications and First Aid Kit will be stored, locked, and maintained in staff office on a first floor. The kitchen knives locked in a lock box and were observed to be also stored in a staff office. Kitchen cleaning supplies will be stored in a locked cabinet. Appliances in the kitchen appeared to be functional. The laundry area is located on a first floor. Additional cleaning supplies will also be maintained and locked in a closet by the laundry area. The garage has an access from inside the house and was observed to be locked and inaccessible. The garage is used for additional storage for emergency food supplies, tools and unused furniture. The necessary precautions have been made to the facility to safely house the residents such as auditory alarms and locked areas for centrally stored medications. Facility appears to be clean and in good repair.

In addition to inspecting the inside of the facility, the outdoor, front and back yards were also inspected. Sitting areas and outside furniture were observed to be in good repair. Lawn is properly maintained. There is a swimming pool, which has a five-foot fence around its parameters to prevent clients from entry unsupervised. In order to gain access, the fence has a gate which will be locked at all times. Both front and back yards were observed to be clear of any obstruction.

During the Pre-Licensing visit Component III interview completed with the Administrator. In addition, LPA informed the Administrator that they cannot under any circumstances do detox treatment at this facility.

Pursuant to Title 22, the facility is compliant to regulation, and ready for licensure. This report will be forwarded to the Centralized Application Bureau (CAB). The applicant will be notified by the CAB Analyst when their license is approved.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2