<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610378
Report Date: 03/17/2023
Date Signed: 03/17/2023 09:58:56 AM

Document Has Been Signed on 03/17/2023 09:58 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:EMINENCE RESIDENTIAL HOMEFACILITY NUMBER:
197610378
ADMINISTRATOR:KATONGOLE, KENNETHFACILITY TYPE:
735
ADDRESS:11451 DANUBE AVETELEPHONE:
(818) 770-0324
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 4CENSUS: 0DATE:
03/17/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Moses Wakabi, Kenneth KatongoleTIME COMPLETED:
10:00 AM
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) Michael Cava conducted a Pre-Licensing Inspection and Component III with the applicant and administrator, Moses Wakabi and Kenneth Katongole. An Application to operate an Adult Residential Facility (ARF) was received by Community Care Licensing (CCL) on November 15, 2022. A fire clearance was approved on January 27, 2023 for four (4) ambulatory only clients The smoke alarms are hard wired and inter-connected. There is a carbon monoxide detector installed in the hallway by client bedrooms that is functional. The facility has a fully charged fire extinguisher located in between the kitchen and laundry area.

A tour of the physical plant was initiated at approximately 8:50am and the following was observed:

KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven and sink. The Hot water delivered is measured at 120 degrees F. There were adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of four (4) clients.

BEDROOMS: There are four (4) bedrooms designated for client use. All four bedrooms are for ambulatory clients only. All four bedrooms are for private use and were equipped with one bed, night stand, chair, dresser, bedding and linen. Each bedroom has sufficient lighting and closet space. Passageways were clear of obstruction.

BATHROOMS: The facility has three (3) bathrooms. Bedroom #4 has it's own bathroom with shower and tub. The other two bathrooms are located by the facility entrance/exit, and at the hallway, between bedrooms #2 and #4. The bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 120 degrees.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2023
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: EMINENCE RESIDENTIAL HOME
FACILITY NUMBER: 197610378
VISIT DATE: 03/17/2023
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
COMMON AREAS: These included the living room and dining room. The living room is equipped with furniture, table and a television. There is a fireplace that is non-operational. LPA did not observe any fireplace tools or fixtures present. The dining area has a large dining room table to accommodate six (6) clients. There were no visible immediate hazards.

LAUNDRY ROOM: The laundry room is located adjacent to the kitchen and dining room. There were no cleaning supplies observed.

MEDICATIONS: The medication closet is located in the hallway, by the exit/entrance area. LPA observed the closet door to have a lock which requires a key to open. Client and staff files will also be maintained there. In addition, there was a complete first aid kit and manual stored in the closet.

OFFICE/STAFF WORKSTATION: There is a staff office located at the backyard of the facility. This area will remain locked and inaccessible to clients at all times during operation.

SURROUNDING GROUNDS: The passageways and entrance to the home was clear of obstruction. Smoke alarms were tested and operational. The backyard of the facility has sufficient yard space for client activities. LPA observed a basketball court for clients to utilize. The side gates were inspected to insure there no locks installed. Gates were easy to open in case of an emergency.

Pursuant to Title 22, Division 6 of the CA Code of Regulations, 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: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2