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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610462
Report Date: 03/07/2024
Date Signed: 03/07/2024 05:06:57 PM

Document Has Been Signed on 03/07/2024 05:06 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:AN ELITE CHATEAUFACILITY NUMBER:
197610462
ADMINISTRATOR:MCLELLAND, MARY JANEFACILITY TYPE:
740
ADDRESS:500 GEORGIAN ROADTELEPHONE:
(562) 541-2267
CITY:LA CANADASTATE: CAZIP CODE:
91011
CAPACITY: 6CENSUS: 6DATE:
03/07/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:07 PM
MET WITH:Mary Jane McLelandTIME COMPLETED:
05:08 PM
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an announced Pre-Licensing visit to this facility and met with Mary Jane McLeland, Administrator. Facility is fire cleared for three ambulatory, two non-ambulatory and one bedridden. Currently there are six residents in care. Visit was conducted on 03/07/2024. Component three was also conducted and completed on 03/07/2024.

LPA was given a tour of the physical plant. Facility has seven bedrooms. Two bedrooms are designated for staff. Six bedrooms are private bedrooms. LPA observed all bedrooms to be appropriately furnished. There are five bathrooms. One bathroom is designated for staff. All resident bathrooms have grab bars and non skid mats. Hot water was observed by LPA and administrator to be at 120 degrees by using a thermometer. The facility smoke alarm system and carbon monoxide are operable. LPA checked the kitchen area for the ability to prepare and store food. LPA observed knives, sharp objects, and cleaning supplies to be locked away and inaccessible. Medications will be locked in kitchen cabinets. Emergency telephone numbers are on the kitchen wall along with other required posters. There is a working telephone on the premises.

LPA toured all common areas. LPA observed the home to be clean and furniture to be in good condition. In the back of the home is a swimming pool that has a locked gate and is inaccessible to residents.

LPA will notify Centralized Application Unit regarding component three being complete along with the pre-licensing visit having been conducted.

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


SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024
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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