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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610454
Report Date: 02/23/2024
Date Signed: 02/23/2024 12:17:25 PM

Document Has Been Signed on 02/23/2024 12:17 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:AMAZING YAPO HOME LLCFACILITY NUMBER:
197610454
ADMINISTRATOR:TAYEBWA, ONESMUSFACILITY TYPE:
735
ADDRESS:7856 RUDNICK AVENUETELEPHONE:
(818) 287-1316
CITY:CANOGA PARKSTATE: CAZIP CODE:
91304
CAPACITY: 4CENSUS: 0DATE:
02/23/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:51 AM
MET WITH:Onesmus Tayebwa, AdministratorTIME COMPLETED:
12:20 PM
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At 10:00am, Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an announced Pre-Licensing visit to this facility and met with the Administrator. This is an initial application. 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.

Today’s site visit consisted of LPA touring the physical plant inside and outside and observed the following:

Facility Fire clearance was conducted on 08/23/23 and approved for four (4) Ambulatory clients only. The facility has dual carbon monoxide and smoke alarm system. There is a fire extinguisher located in the kitchen with a date of purchase of 02/16/2024. There will be a functioning telephone on the premises. An emergency exit plan/sketch is posted in each bedroom and in the hallway wall with other posting requirements. There are four (4) bedrooms designated for clients use. Clients bedrooms were observed to be appropriately furnished. There are two (2) bathrooms in the facility. Bathrooms have non-skid mats and appropriate grab bars. Trash cans were observed to have closed tight fitting lids.

The common areas (living room, kitchen, and dining areas) were appropriately furnished, and lighting was adequate. The living room has a television and comfortable furniture. Clients, staff records and medication will be stored in a locked kitchen cabinet. There are (2) first aid kit is readily available.

The kitchen knives are stored in a locked drawer. The kitchen cleaning supplies are stored in a locked cabinet. Laundry detergents, cleaning supplies and other toxins are stored in an attached garage. LPA observed the garage to be locked and inaccessible to clients in care. Facility appears to be clean and in good repair. Appliances in the kitchen appeared to be functional.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2024
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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: AMAZING YAPO HOME LLC
FACILITY NUMBER: 197610454
VISIT DATE: 02/23/2024
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There will be a sitting area in the backyard for residents to conduct outdoor activities. The outdoor, front and back yards were free of any obstruction. There is no body of water.

Component III was conducted with applicant.

No deficiencies issued with this report. 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. A copy of this report was signed and delivered.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
LIC809 (FAS) - (06/04)
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