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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610564
Report Date: 08/07/2024
Date Signed: 08/19/2025 09:55:13 AM

Document Has Been Signed on 08/19/2025 09:55 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:SWINTON HOMEFACILITY NUMBER:
197610564
ADMINISTRATOR/
DIRECTOR:		ANDRES, CHARMILEYFACILITY TYPE:
735
ADDRESS:9214 SWINTON AVE.TELEPHONE:
(714) 519-8997
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 4CENSUS: 0DATE:
08/07/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:28 AM
MET WITH:Pana, Lora MayTIME VISIT/
INSPECTION COMPLETED:
11:39 AM
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On 11.29.2023 Licensing Program Analyst (LPA) Leslie Ngo-Castaneda arrived at facility at 9:28am to conduct a pre-licensing inspection with the assistant-administrator. Lora May Pana (assistant- administrator) was greeted upon entering the facility. An application to operate a Adult Residential Facility for (ARF) was received by Community Care Licensing (CCL) on 10.27.2023. A fire clearance was approved on 6.4.2024 for four (4) bedridden, for a total capacity of four (4). The smoke alarms and carbon monoxide detector are hard wired and inter-connected. The facility has one new fire extinguishers that was purchased on 7.8.2024. One fire extinguisher is located in the kitchen in between the laundry and dining table.

A tour of the physical plant was initiated at approximately 9:42 AM and the following was observed:

KITCHEN: The facility has a kitchen area that is equipped with a refrigerator, microwave oven, and sink. There were adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). LPA inspected the kitchen and observed gas stove and refrigerator to be clean and working. Knives and sharps are stored in a locked cabinet under the sink. Cleaning agents are also stored under the sink with a locking mechanism.

BEDROOMS: There are four (4) bedrooms designated for client use in the hallway. Bedroom #1, room #2, room #3 and room #4 are cleared to be private rooms. The applicant furnished the resident bedrooms with beds, night stand, chairs, dresser, bedding, and linen. The bedrooms have sufficient lighting and closet space. The linens were stored in the storage space in each residents bedrooms.

Continue to LIC 809-C
NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Leslie Ngo-Castaneda
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2024
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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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: SWINTON HOME
FACILITY NUMBER: 197610564
VISIT DATE: 08/07/2024
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BATHROOMS: The facility has two (2) bathrooms. Residents bathroom is located beside bedroom #1. The bathroom were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 107.8 degrees Fahrenheit. Bathroom #2 is located in between bedroom #3 and bedroom #4. Hot water delivered in the bathroom measured at 108.3 degrees Fahrenheit.

COMMON AREAS: The common areas were appropriately furnished these included the living and dining room area. The living room was equipped with couch, a television, tables and chairs. The LPA observed entertainment equipment and games for activities. The dining table is large enough to seat six (6) individuals. The facility has maintained a temperature of 72 degrees Fahrenheit. There were no visible immediate hazards. Water and emergency kits are stored in a cabinet in the kitchen.



LAUNDRY ROOM: The laundry room is located in between the kitchen and the dining table. It was observed with a closed door closet. The washer and dryer are brand new. All chemicals were stored and locked under the kitchen sink.

MEDICATIONS: The medications will be located in the kitchen. It has a locking mechanism.

OFFICE/STAFF WORKSTATION: The facility has a staff workstation that is in between the living room and the dining table The first-aid kit is complete. Designated files will be stored in the cabinet by the kitchen.

SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. All entry and exit doors have a functional auditory alert when the doors open. There is sufficient outdoor space with seating and a shaded area with proper furniture for outdoor use. There are no bodies of water on the premises.

Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment appears to be compliant and ready for licensee. CAB will be advised, and a copy of this report provided. No health and safety hazard were noted during this visit. Licensee shall contact LPA once the first resident is admitted. Exit interview was conducted and a copy of report was issued.

In addition to the pre-licensing inspection, a Component III power point presentation was also held.
NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Leslie Ngo-Castaneda
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
LIC809 (FAS) - (06/04)
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