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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610560
Report Date: 10/02/2024
Date Signed: 10/02/2024 04:31:32 PM

Document Has Been Signed on 10/02/2024 04:31 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:NASIM & OLANO HOMES, LLCFACILITY NUMBER:
197610560
ADMINISTRATOR/
DIRECTOR:		OLANO, HUGOFACILITY TYPE:
735
ADDRESS:8362 VANALDEN AVETELEPHONE:
(818) 310-5070
CITY:NORTHRIDGESTATE: CAZIP CODE:
91324
CAPACITY: 4CENSUS: 0DATE:
10/02/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Christian OlanoTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 10/2/2024 at 10:00am, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted an announced Pre-Licensing Inspection at the facility, met with the Licensee/Administrator Christian Olano and conducted an 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 two (02).
Fire Clearance was approved on 07/08/2024 for a maximum capacity of four (4) ambulatory clients. This is a single story house with three (3) bedrooms and two (2) bathrooms. Bedrooms #1 and #2 designated for a capacity of four 4 clients, and bedroom #3 is designated for staff use. Facility will have an awake night shift staff on premises. At 10:35am a physical plant was toured inside and out of the property with the assistance of the Licensee and the following was observed:

Kitchen Area: The kitchen is equipped with a refrigerator, microwave, oven, and sink. The facility has adequate supplies of two (2) days of perishable and seven (7) days of nonperishable food. LPA observed dining ware to accommodate a maximum capacity of four (4). The stove and the refrigerator were clean and in good operation. All knives and sharps are observed to be locked in a cabinet located next to the kitchen area and inaccessible to clients. Chemicals are\will be kept in a locked cabinet under the sink. The facility has one (1) new fire extinguisher, appeared to be full and serviced and was last purchased on 05/15/2024.
Bedrooms: There are three (3) bedrooms in the facility of which two (2) are designated for clients’ use. Both bedrooms are set to be shared. All bedrooms are furnished and well equipped with bed, night stand, chair, dresser, bedding, pillowcase, mattress pad, and blankets, extra linen are available in the cabinet located in the hallway. Rooms were observed to have sufficient lighting and closet space. 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. Facility will have an awake staff.
Continue on LIC809-C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
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: NASIM & OLANO HOMES, LLC
FACILITY NUMBER: 197610560
VISIT DATE: 10/02/2024
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BATHROOMS: The facility has two (2) bathrooms, bathroom #1 designated for the clients’ use, bathroom #2 is designated for staff. Both bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 11:45am to be at 114°F degrees.

COMMON AREAS: At 10:45am LPA observed the living/family room and dining room furniture to be clean and in good repair. The fireplace located in the dining room is adequately closed and inaccessible. The facility maintains a comfortable temperature at 75°F. The air conditioner is operational. No firearms observed or will be maintained on the premises. LPA observed computer desk in the activity room where clients can have access and communicate with friends/family members. Licensee has ordered puzzles, books, balls, and board games to provide activities to clients in care. No obstructions and or tripping hazards observed throughout the facility.

Laundry Area: The laundry room is located in the separate area next to the kitchen. The washer/dryer appear to be new and in good condition. Laundry supplies and other chemicals are kept locked in the laundry cabinet, inaccessible under supervision when not in use.



Medications: LPA observed medications along with first-aid kit will be kept centrally stored and locked in a cabinet located in the laundry area and the key cannot be accessible to clients in use.
LPA also observed clients and staff files will be kept locked in a cabinet located in the hallway. First-aid kit is complete and has new manual.

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. Facility has land-line which was checked at 11:05am to be operational.

SURROUNDING GROUNDS: The facility has sufficient yard space. LPA observed the backyard with appropriate outdoor furniture and covered shaded area for clients. There is a pool in the backyard, properly fenced and locked with 5ft fences. LPA discussed the importance of maintaining the care and supervision to meet the needs of clients. There is no garage in the property. The side gate leading from the backyard to the front yard was not locked.

Continue on LIC809-C

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

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
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: NASIM & OLANO HOMES, LLC
FACILITY NUMBER: 197610560
VISIT DATE: 10/02/2024
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Component III was conducted with the Licensee/Administrator.

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

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

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

DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024
LIC809 (FAS) - (06/04)
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