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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610642
Report Date: 02/19/2025
Date Signed: 02/20/2025 04:50:55 PM

Document Has Been Signed on 02/20/2025 04:50 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:ROME'S HOME CARE SERVICESFACILITY NUMBER:
197610642
ADMINISTRATOR/
DIRECTOR:		MONICO, GIOVANYFACILITY TYPE:
735
ADDRESS:10140 VENA AVETELEPHONE:
(818) 383-3154
CITY:ARLETASTATE: CAZIP CODE:
91331
CAPACITY: 6CENSUS: 0DATE:
02/19/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:06 AM
MET WITH:Giovany Monico, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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At 10:00am Licensing Program Analysts (LPA) Leizl de la Cerra conducted an announced Pre-Licensing Inspection to the above facility and met with administrator, Giovany Monico The LPA will inspect the facility to ensure compliance with the rules and regulations under California Code of Regulations, Title 22, Division 6.

Fire Clearance was approved on 09/14/2024 for a maximum capacity of six (6) non-ambulatory clients. At 10:15am, with the assistance of the administrator, LPA conducted a facility tour of both the inside and outside premises and observed the following:

KITCHEN: The kitchen is equipped with a refrigerator, stove, microwave oven and sink. LPA observed adequate supplies of nonperishable food and dining ware to accommodate a maximum capacity of six (6). All knives and sharps are observed secured in a cabinet located between the kitchen area and laundry room area, inaccessible to clients.

BEDROOMS: There are four (4) bedrooms designated for clients to use. All bedrooms are furnished with a night stand, a chair, a lamp, a chest of drawers, a closet and a bed with clean bedding and linens. All bedrooms have sufficient closet space and have sufficient lighting.

BATHROOMS: LPA observed two (2) bathrooms that are clean and in good repair. One (1) bathroom designated for client use and the other one for staff use. Properly supplied with toilet papers, soap and paper towels. The hot water temperature measured at 107°F. LPA observed the appropriate grab bars by the bathroom toilet and in the shower areas. LPA observed non-skid mats in the shower area.

Continued to LIC809-C
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE: DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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 2
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: ROME'S HOME CARE SERVICES
FACILITY NUMBER: 197610642
VISIT DATE: 02/19/2025
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COMMON AREAS: The facility maintains a comfortable temperature at 70°F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the common areas.

SURROUNDING GROUNDS: LPA observed an attached garage with a lock which will be used for storage. LPA observed the backyard provides seating area with the appropriate outdoor furniture, available for clients to use. No obstructions and or tripping hazards observed in the backyard.



LAUNDRY AREA: LPA observed laundry area is located beside the kitchen area separated by a locked door which is inaccessible to clients. Cleaning compounds, detergents and soaps were observed in this area. The washer/dryer appear to be in good condition.

LPA observed a cabinet with a lock which will secure the medications, client files and staff files located in the area between the kitchen and laundry area which is inaccessible to clients in care. The first-aid kit is complete. The facility smoke alarm system is hard wired and interconnected. The facility uses a dual Carbon Monoxide/Smoke alarm detectors all over the common areas of the facility. Alarms were tested at 10:40am and observed to be operational. The fire extinguisher is located in the kitchen area and was observed to be fully charged.

Component III Orientation was conducted with the administrator/applicant during the visit.
LPA de la Cerra will notify the Centralized Applications Bureau (CAB) Analyst of the completed Pre-Licensing inspection. The CAB Analyst will notify applicant when license is approved.
Exit interview was conducted and a copy of the signed report was provided.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC809 (FAS) - (06/04)
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