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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610378
Report Date: 03/13/2024
Date Signed: 03/13/2024 02:17:04 PM

Document Has Been Signed on 03/13/2024 02:17 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: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:
03/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Moses WakabiTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the administrator, Moses Wakabi and explained the reason for the visit. The facility is a Level IV home. Application for clients is pending with Regional Center. Currently there are no clients.

At approximately 11:45am, with the assistance of the administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms and carbon monoxide detectors are dual and interconnected. There is also an additional carbon monoxide detector installed in the hallway by resident rooms. The fire extinguisher is located in the kitchen. It was purchased on 02/22/24

Kitchen: The kitchen appliances and fixtures were functional. Because there are no clients, perishable food items not required at this time. The LPA did observe a sufficient amount of non-perishable and emergency food items on stock. No knives, sharps, toxins or cleaning supplies were observed out in the open. Knives and cleaning supplies are kept locked underneath the kitchen sink.

Bedrooms: There are four (4) bedrooms designated for residents' use. All four bedrooms are private. LPA observed all four rooms to be properly furnished with appropriate beddings and linens with sufficient lighting.

Bathrooms: There are two (2) bathrooms designated for residents' use. Both bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 120 degrees Fahrenheit. No cleaning supplies were stored in the bathrooms during the inspection.

Common Areas: These included the living room and dining area. The common areas were properly furnished. The floors were mopped and clean, and the furniture were in good repair. The dining room table was large enough to seat anywhere between four to eight persons. Hallways and passageways were clear of obstruction. The fireplace in the living room is not functional. No fireplace tools present.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2024
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: EMINENCE RESIDENTIAL HOME
FACILITY NUMBER: 197610378
VISIT DATE: 03/13/2024
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Surrounding Grounds: Entry/exits were free of obstruction. There was backyard furniture appropriate for outdoor use. The outdoor area is large enough to hold outdoor activities.

Laundry Area: The laundry area is located by the kitchen. There is locked cabinet space above the washer and dryer where detergents will be kept.

Resident Files: Resident files will be kept locked at a hallway closet, in the hallway by the entrance. Currently no resident files to review.

Staff Files: Staff file will also be kept in the same hallway closet as resident files. Currently no staff employed as facility not operating, and is awaiting approval for their application from Regional Center.

Medications: Medication and Medication Records will also be kept in the sane locked closet as resident and staff files.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a copy of this Report Issued.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024
LIC809 (FAS) - (06/04)
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