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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610387
Report Date: 05/09/2024
Date Signed: 05/09/2024 04:12:44 PM

Document Has Been Signed on 05/09/2024 04:12 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:MBI HEALTH SERVICESFACILITY NUMBER:
197610387
ADMINISTRATOR/
DIRECTOR:		WODIN, PHYLLISFACILITY TYPE:
775
ADDRESS:7231 SANTA MONICA BLVDTELEPHONE:
(213) 946-0002
CITY:WEST HOLLYWOODSTATE: CAZIP CODE:
90046
CAPACITY: 60CENSUS: 0DATE:
05/09/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Phylis WodinTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 05/09/2024 at 9:50 am, Licensing Program Analyst (LPA) Raymond Comer arrived at the Facility and met with Administrator Phyllis Wodin. LPA announced purpose of the visit: A Pre-Licensing inspection to ensure that the facility is in compliance with the rules and regulations of California Code of Regulations, Title 22, Division 6.

Applicant is "MBI Health Services Inc.". An application to operate an Adult Day Program (ADP) was received by Community Care Licensing (CCL) on 8/31/2023. Fire clearance was approved on 08/07/2023 for sixty (60) ambulatory, none of which may be non-ambulatory, for a total capacity of sixty (60). Facility has an approved mitigation and infection control plan on file.

At 10:15 am, LPA initiated a tour of the physical plant with the Administrator and the following was observed:

DAYS & HOURS: Facility will operate, Monday through Friday, from 8:00AM through 4:00PM

STRUCTURE: Facility is a two-story building located in a commercially zoned neighborhood. This ADP facility will be used by Clients for recreation, educational, heath-wellness training, and life skills purposes. First floor consists of reception area, Client intake office (for screening of new admits), Nurse Office, three (3) activity rooms, computer work station, and one (1) bathroom. The Second floor consists of Client rest area, three (3) activity rooms, Executive Director Office, two (2) therapy rooms,and two (2) bathrooms.
Facility temperature observed at 75 degrees F; within the required temperature range. Required postings were observed in the entry area. A visitor sign-in sheet, hand sanitizer, gloves, and masks were present at the facility entrance. Walls, floors, ceilings, windows, and screens were observed as clean and in good repair.

[LIC 809C-Continued]
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
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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