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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610635
Report Date: 08/15/2024
Date Signed: 08/15/2024 03:10:36 PM

Document Has Been Signed on 08/15/2024 03:10 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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:SAND CASTLE RESIDENCES LLCFACILITY NUMBER:
197610635
ADMINISTRATOR/
DIRECTOR:		ALONZO, MARIAFACILITY TYPE:
735
ADDRESS:545 N. AVON STREETTELEPHONE:
(516) 382-7880
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY: 4CENSUS: 0DATE:
08/15/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Maria AlonzoTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 8/15/2024 Licensing Program Analyst (LPA) Melissa Spaeth conducted an announced pre-Licensing visit to this facility and met with the Licensee. This is a new application and a fire clearance dated 5/21/2024 was received for four (4) ambulatory residents.

The purpose of today’s visit is to inspect the facility to ensure that it maintains compliance under California Code of Regulations, Title 22, Division 6. Component III was conducted with the applicant from 10:44 until 11:30 am.

Today’s site visit consisted of LPA touring the physical plant inside and outside from 11:45 am until 12:40 pm LPA Spaeth observed the following:

Living Room – the living room is spacious and furnished with comfortable seating.

Kitchen/Dining Room - The facility contained a seven day supply of non-perishable food and a two day supply of perishable foods. A fire extinguisher is also located in the kitchen. Appliances in the kitchen appeared to be functional. The dining room contained a table and chairs. The knives were locked in a kitchen cabinet. The resident files, staff files, and the client medications are locked in a kitchen cabinet.
The cleaning solutions were safely locked underneath the kitchen sink. The first aid kit is located in a dining room drawer.

Bathrooms- There are two bathrooms which contained hand soap, paper towels, and a trash can. The water temperature was tested at 11:15 am and was 116.0 degrees F.

Continued - 809C
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SAND CASTLE RESIDENCES LLC
FACILITY NUMBER: 197610635
VISIT DATE: 08/15/2024
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Bedrooms - There are four bedrooms which contained bed, linens, night stand, lamp, chest of drawers, a chair, a closet, and bath towels that will be stored in the resident's own room..

Backyard - The backyard contained a shaded area with a seating area for residents to enjoy outside activities. The side gate leading from the backyard to the front yard was not locked. There is also a locked tool shed in the backyard.

Detached Garage – The washer/dryer, additional cleaning solutions and emergency water are locked in the garage.

The smoke and carbon monoxide detectors were tested at 12:50 pm and were operable. The facility was clean and appears to be in good repair.

This report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC809 (FAS) - (06/04)
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