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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610511
Report Date: 04/12/2024
Date Signed: 04/12/2024 11:54:49 AM

Document Has Been Signed on 04/12/2024 11:54 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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:VALLEY CONNECTIONS RODAXFACILITY NUMBER:
197610511
ADMINISTRATOR/
DIRECTOR:		RAHMATI, FARHADFACILITY TYPE:
735
ADDRESS:21018 RODAX STTELEPHONE:
(818) 223-7299
CITY:CANOGA PARKSTATE: CAZIP CODE:
91304
CAPACITY: 4CENSUS: 0DATE:
04/12/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Farhad RahmatiTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 04/12/2024 at 10:05 am, Licensing Program Analysts (LPAs) Raymond Comer and Micheal Cava announced purpose of visit for conducting a Pre-Licensing evaluation of the Facility. LPAs met with Administrator/Licensee Farhad Rahmati. An application to operate an Adult Residential Facility (ARF) Level II, was received by Community Care Licensing (CCL) on 10/03/2023. A fire clearance was approved on 03/04/2024, for two (2) ambulatory residents and two (2) non-ambulatory residents for a total capacity of four (4).

A tour of the physical plant was initiated at approximately 10:15 a.m. and the following was observed: A single story facility with an attached garage.

KITCHEN area is clean and clear of clutter. LPAs observed a refrigerator, microwave, stove/oven, dishwasher and sink to be operational. Plates, cups, utensils, A supply of perishable, and nonperishable food will be available upon facility's receipt of first resident. Knives/Sharps will be kept in observed in a locked kitchen drawer. Cleaning supplies and chemicals are\will be kept in a locked cabinet area in the garage and inaccessible to residents.

BEDROOMS: Facility has four (4) total bedrooms. Bedroom #1 is a shared resident room with its own Bathroom. Bedroom #2 and Bedroom#3 are private rooms for residents. Bedroom#4 is a space for Staff. All residents bedrooms observed with required beds, night stands, chairs, dressers, linens and appropriate lighting.

BATHROOMS: Facility has two (2) total bathrooms. Proper fixtures are working properly; grab bars and anti-slip matting observed. Paper towels, hand soap, toilet paper, and toiletries are observed. Hot water delivered to bathrooms measured a temperature between 108 degrees F. Within the required range.

Continued on 809-C
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2024
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: VALLEY CONNECTIONS RODAX
FACILITY NUMBER: 197610511
VISIT DATE: 04/12/2024
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COMMON AREAS: Dining room is furnished with table large enough to accommodate the capacity of the facility. Living room area maintains a sitting area, television, stored games, reading materials, and a screened fireplace. No fireplace tools present. Furniture and fixtures are clean and good condition.

FIRE SAFETY: Smoke alarms are hard wired and inter-connected. Applicant tested smoke detectors at 11:15 a.m. and observed them as functional. Carbon monoxide detector tested and observed as functional. Fire extinguisher is located along wall in dining room area; purchase date on 03/07/2024.

LAUNDRY: Washer and Dryer equipment is located in the garage. Cleaning detergents and toxins are store stored in garage area cabinets inaccessible to residents.

GARAGE: The garage is attached to house and inaccessible to residents. Currently used to store facility items.

MEDICATIONS: Medications will be stored in a locked upper level hallway cabinets.

STAFF\RESIDENT RECORDS: Staff and Client records will also be stored in in a locked upper level hallway cabinets. The applicant was advised to ensure all records will be accessible to the licensing agency upon request or during inspection. Facility will have awake staff.

SURROUNDING GROUNDS: The driveway, passageways and entrance to the home are clear of obstruction. Backyard area will have patio sufficient furniture and for shaded area upon admission of first resident. Property has a pool. Pool is fenced and will be be locked upon admission of first resident.

The Component III presentation was conducted at approximately 10:15 a.m. with administrator/licensee. An exit interview was conducted and a copy of this report has been furnished to the administrator.

Per observation, the physical plant is compliant with title 22 and ready for licensure. Applicant is advised and a copy of this report provided and will be forward to Central Applications Bureau (CAB).
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024
LIC809 (FAS) - (06/04)
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