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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610435
Report Date: 08/28/2024
Date Signed: 08/28/2024 11:45:15 AM

Document Has Been Signed on 08/28/2024 11:45 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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:GRETCHEN HOMEFACILITY NUMBER:
197610435
ADMINISTRATOR/
DIRECTOR:		BRANDY MAYNARDFACILITY TYPE:
735
ADDRESS:41024 GRETCHEN WAYTELEPHONE:
(626) 500-1430
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY: 4CENSUS: 0DATE:
08/28/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Brandy MaynardTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 8/28/2024 Licensing Program Analyst (LPA) Melissa Spaeth conducted an announced pre-Licensing visit to this facility and met with the Administrator. This is a new application and a fire clearance dated 2/09/2024 was received for four (4) non-ambulatory clients.

The purpose of today’s visit is to inspect the facility to ensure that it maintains compliance under California Code of Regulations, Title 22, Division 6. Component III was conducted with the Administrator at 9:40 am until 10:10 am. Today’s site visit consisted of LPA touring the physical plant inside and outside from 10:10 am until 10:40 am. LPA Spaeth observed the following:

Living Room – the living room is spacious and contained comfortable seating.

Office - The medications, first aid kit, PPE, client files, and resident files will be locked in a cabinet within the office.

Kitchen/Dining Room - The knives were locked in a kitchen drawer and the cleaning solutions were safely locked underneath the kitchen sink. A fire extinguisher is also located within the kitchen area. Appliances in the kitchen appeared to be functional. The dining room area is spacious and contains a dining room table and comfortable seating.

Family Room– LPA observed the family room was spacious and contains comfortable seating and a television.


Continued - 809C
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GRETCHEN HOME
FACILITY NUMBER: 197610435
VISIT DATE: 08/28/2024
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Backyard - The backyard contained a shaded area with comfortable seating. A staff break area is located in a building in the backyard. Another building is used for storage. The side gate leading from the backyard to the front yard was not locked.

Garage - The garage is a designated game room and contains various games and a stationary bike. The emergency water and emergency food are stored in the garage.

Bedrooms - There are four bedrooms which contained bed, linens, night stand, lamp, chest of drawers, a chair and a closet.

Bathrooms- There are three bathrooms which contained hand soap, paper towels, and trash can. The water temperature was tested at 10:20 am and was 119.0 degrees F.

Hallway - The hallway closets contained personal hygiene items, towels, and client linens.

Laundry Room – the laundry room contains the washer and dryer. The laundry detergent and additional cleaning solutions are safely locked in a laundry room cabinet.

Smoke and Carbon Monoxide Detectors - the detectors were tested at 10:30 am and were operable.

This report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved.

Exit interview was conducted and a copy of the report was given.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC809 (FAS) - (06/04)
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