198203062-9-21-2022-31-AS-NRED-CJGRZV-20220921132835

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198203062
Report Date: 09/21/2022
Date Signed: 09/21/2022 01:28:48 PM

Document Has Been Signed on 09/21/2022 01:28 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	FRANK CALA HOUSE		FACILITY NUMBER:	198203062
ADMINISTRATOR:	RAFAEL LOPEZ		FACILITY TYPE:	736
ADDRESS:	8500 HANNA STREET		TELEPHONE:	(818) 347-1777
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91304
CAPACITY: 6		CENSUS: 6	DATE:	09/21/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Esmerelda Puente		TIME COMPLETED:	01:37 PM

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At approximately 11:45 a.m. on 09/21/2022 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual visit. LPA met with the Assistant Administrator and disclosed the reason for the visit. LPA and Assistant Administrator toured the facility inside and out.

The facility was last visited on 08/23/2021 for an annual visit. It is a single story building with 4 bedrooms, 2 bathrooms, kitchen, garage, common areas, office areas, and outdoor areas.

LPA observed a maintained front yard. A ramp in good condition led to the main entrance. A sign regarding the facility’s masking policy hung on the front. LPA was screened for infectious disease upon entry. The screening station contained digital thermometer, surgical masks, gloves, and a visitor log. The visitor log tracked temperature, symptoms, and vaccination status. Postings near the entrance included house rules, grievance policy, facility sketch, facility license, activity calendar, and COVID precautions. Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. Medication was locked in a closet near the main entrance. Resident files were locked near the dining room table. The living room contained arts and crafts supplies, reading material, television, and board games, At 12:29 p.m. LPA measured the room temperature to be 72 degrees Fahrenheit. Kitchen appliances were sanitary and functional. At 12:34 p.m. LPA measured the refrigerator and freezer temperatures to be 40 and -16 degrees Fahrenheit, respectively. A facility menu and a temperature log hung on the side of the refrigerator. LPA observed an adequate supply of perishable and non-perishable food in the kitchen and the garage. A ramp led out to the garage. The garage contained a washer and dryer in good condition, along with PPE, locked cleaning supplies, and an extra refrigerator and freezer. The laundry machines had a laundry schedule posted. The back yard contained two sets of covered patio furniture. Both were in good condition. LPA also observed a gas grill, a maintained lawn, and additional seating arrangements. A shed on the south side of the facility contained a biohazard disposal unit.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: FRANK CALA HOUSE	FACILITY NUMBER: 198203062
	VISIT DATE: 09/21/2022

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The facility had 4 bedrooms. 2 were private and 2 were shared. 3 out of 6 residents were observed in bed listening to music. All bedrooms contained a chair, nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition. At approximately 12:37 p.m. LPA observed 2 fully charged fire extinguishers in the hallway and in the kitchen.

The facility had 2 bathrooms. All bathrooms contained liquid soap, paper towels, handwashing instruction sign, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At approximately 12:40 p.m. LPA measured the water temperature in the shared bathroom to be 109.6 degrees Fahrenheit.

All emergency exit paths were free from obstructions. The exit gate was unlocked with an inward facing latch. At 12:53 p.m. LPA tested the smoke detector to be operational. At 12:54 p.m. LPA tested the carbon monoxide detector to be operational.

During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC809 (FAS) - (06/04)

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