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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610530
Report Date: 05/24/2024
Date Signed: 05/24/2024 11:44:10 AM

Document Has Been Signed on 05/24/2024 11:44 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:NALA HOUSE INC.FACILITY NUMBER:
197610530
ADMINISTRATOR/
DIRECTOR:		KANALEY, TASHAFACILITY TYPE:
735
ADDRESS:38164 NALA CIRCLETELEPHONE:
(661) 802-8413
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY: 6CENSUS: 0DATE:
05/24/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:TASHA KANALEY-AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 5/24/2024 at 10:00am, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an announced Pre-Licensing Inspection at the facility, met with the Licensee/Administrator Tasha Kanley and conducted entrance interview.

This is a North Los Angeles Regional Center vendored facility and the licensee is planning to serve the client with intellectual disabilities at level four (04).
Fire Clearance was approved on 12/07/2023 for a maximum capacity of six (6) ambulatory clients. The facility has five (5) bedrooms and three (3) bathrooms designated for a capacity of 6 clients. There is no bedroom designated for staff and there will be awake night shift staff on premises.
The physical plant was toured inside and out with the assistance of the Licensee.

Common Area: At 10:15am LPA observed the living/family room and dining room furniture to be clean and in good repair. The fireplace located in the family room is adequately closed and inaccessible. The facility maintains a comfortable temperature at 68°F. The air conditioner is operational. No firearms observed or will be maintained on the premises. LPA observed puzzles, books, balls, and board games to provide activities to residents in care.

Kitchen Area: The kitchen is equipped with a refrigerator, microwave, oven, and sink. The licensee will supply the facility with perishable and nonperishable food upon arrival of the clients. LPA observed dining ware to accommodate a maximum capacity of six (6). The stove and the refrigerator were clean and in good operation. All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to clients. Cleaning supplies and chemicals are\will be kept in a locked cabinet area in the laundry room and inaccessible to residents. The facility has four (4) new fire extinguishers, appeared to be full and serviced and were last purchased on 12/07/2023.
Continued on LIC 809-C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: NALA HOUSE INC.
FACILITY NUMBER: 197610530
VISIT DATE: 05/24/2024
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Medications: LPA observed medications will be kept centrally stored and locked in a cabinet in the kitchen area and the key cannot be accessible to clients in use.
The First Aid kit observed to be new and complete, along with clients and staff files will be locked in a storage room in the living room area.

Bedrooms: From 10:35am to 10:45am LPA observed five (5) bedrooms to be properly furnished and have appropriate bedding sheets, pillowcase, mattress pad, and blankets. Bedrooms are in good condition, have sufficient closet space and may be used for private or as shared. There is at least one chair, nightstand, and sufficient lighting for each client. LPA observed appropriate window screens. Sufficient supplies of personal hygiene products stored in the storage area will be provided to the clients by the Licensee.

Bathrooms: LPA toured 3 bathrooms and checked to make sure bathrooms were clean and in good repair. All bathrooms are properly supplied with toilet papers, soap, and paper towels. The hot water temperature measured at 10:55am to be 108°F. LPA observed appropriate grab bar and non-skid mat in each bathroom. Trash cans have lids to protect consumers from cross contamination.

Laundry Area: The laundry room is located in the separate locked area in the hallway between living room and the bedrooms. The washer/dryer appear to be new and in good condition. Laundry supplies are kept locked inaccessible under supervision when not in use.

SMOKE DETECTORS/CARBON MONOXIDE. Smoke detectors and carbon monoxide were located throughout the facility. At 11:15am they were tested and observed to be operational. No obstructions and or tripping hazards throughout the facility.

Outside areas: LPA toured the outside area of the facility. LPA observed the backyard is fully fenced and has sufficient yard space. There is an appropriate outdoor furniture with a covered shaded area for clients. There are no bodies of water. The side gate leading from the backyard to the front yard was not locked.

Continued on LIC 809-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: NALA HOUSE INC.
FACILITY NUMBER: 197610530
VISIT DATE: 05/24/2024
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The garage: LPA observed attached garage to the home, which is kept locked inaccessible to clients. It is currently being used as storage for holiday decorations and additional supplies for clients. A second refrigerator is also located in the garage.

In addition to the Pre-Licensing inspection, a Component III power point presentation was conducted with the Administrator.

Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and be notified by the CAB Analyst when your license has been approved.

Exit interview was conducted and with a copy of this report was provided to the Applicant/Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
LIC809 (FAS) - (06/04)
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