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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600369
Report Date: 04/17/2024
Date Signed: 04/17/2024 05:39:08 PM

Document Has Been Signed on 04/17/2024 05:39 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:ADLA INC. #1FACILITY NUMBER:
198600369
ADMINISTRATOR/
DIRECTOR:		AIDINOVA, SALBIFACILITY TYPE:
735
ADDRESS:14318 RUNNYMEDE STREETTELEPHONE:
(818) 787-6532
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY: 4CENSUS: 4DATE:
04/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:28 AM
MET WITH:Liana Aidinova, LicenseeTIME VISIT/
INSPECTION COMPLETED:
05:45 PM
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Licensing Program Analyst(LPA) Christine Yee conducted an unannounced required Annual Inspection using the entire CARE INSPECTION TOOL. LPA Yee was let into the home by Raelynn Urbanski, Staff. Liana Aidinova, Licensee was contacted by staff and she arrived a little later to conduct the visit. The reason for today's visit was explained.

The facility is a single storey family home consisting of a living room, dining room, kitchen, 4 bedrooms of which one is used by live-in staff and 3 full bathrooms. The facility is fire cleared for 4 AMBULATORY clients.

On today's visit, LPA Yee reviewed 4 client files, 5 staff files and reviewed all 12 domains of the CARE Inspection Tool and the following were observed on today's visit:
  • the living room and dining room are furnished with the appropriate seating for 4 clients. The only carbon monoxide detector is located in the dining room. It was tested and was operational
  • the kitchen is equipped with a stove, dishwasher, refrigerator, toaster, microwave and coffee maker. Perishable foods for a minimum of 2 days and non-perishable foods for a minimum of 7 days were observed. Located in the kitchen is the only fire extinguisher. It was last inspected on 1/24/24
  • the laundry room was observed with a washer and dryer. Medications, sharp knives and cleaning supplies are stored in locked cabinets located in the laundry room
  • Bedroom #1 is a shared room, located by the front door and was observed with the required furniture. Located inside the room is a private bathroom equipped with a toilet, shower stall, a vanity with a single sink. Water temperature was tested and read 109.3 degrees Fahrenheit.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE: DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2024
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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: ADLA INC. #1
FACILITY NUMBER: 198600369
VISIT DATE: 04/17/2024
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  • Bedroom #2 and Bedroom #3 are single occupancy rooms and had the required furniture.
  • the common bathroom located between bedroom #2 and #3 is equipped with a toilet, bathtub with a shower and a vanity with 2 sinks. Water temperature tested 107.6 degrees Fahrenheit.
  • extra linens were observed in the hall closet
  • the facility has a land line. Telephone number is (818)787-6532
  • the first aid kit was reviewed and met Title 22 requirements.
  • the smoke detectors located in all the bedrooms and in the hallway were tested and were operational.
  • all staff had current first aid cards.
  • liability insurance was reviewed and met the $1 million per occurrence and $3 million total aggregate limits.
  • Surety bond was reviewed and the coverage purchased is for $5 thousand.
  • Per tour of the outside areas, tables and chairs were observed on the covered patio. The backyard is enclosed and has side gates. Trash cans were tightly sealed. Overall the back yard was clean.



No citations were issued on today's visit.

Exit interview was conducted.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Christine Yee
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024
LIC809 (FAS) - (06/04)
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