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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198600370
Report Date: 04/26/2024
Date Signed: 04/26/2024 12:42:35 PM

Document Has Been Signed on 04/26/2024 12:42 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. #2FACILITY NUMBER:
198600370
ADMINISTRATOR/
DIRECTOR:		AIDINOVA, SALBIFACILITY TYPE:
735
ADDRESS:6731 LENNOX AVENUETELEPHONE:
(818) 997-6216
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 4CENSUS: 4DATE:
04/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Liana AidinovaTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Valeria Conway arrived unannounced to conduct a one year required annual at 9:02 a.m. The last annual conducted at this facility was on 04/27/2023. Upon arrival, the LPA was greeted at the door by Licensee Liana Aidinova. The Administrator, Salbi Aidinova arrived shortly after and the reason for the visit was explained. Entrance interview conducted.

At 9:45 p.m., the LPA along with Licensee toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

Kitchen: At 9:56 LPA hot water was measured at 116.1 degrees Fahrenheit at the time of the visit. The facility has a sufficient supply of non-perishable and perishable food items. Knives and sharps are stored in a locked cabinet adjacent to the dining room. Facility has a portable carbon monoxide detector install on the kitchen’s wall, it was tested and was operational at the time of the visit.

Common areas: Living and dining room furniture were observed to be in good condition. At 10:09 a.m., hard wired smoke detectors were tested and were operational at the time of the visit. The LPA observed required postings throughout the common spaces. The fire extinguisher was charged and serviced on 01/24/2024. A first aid kit and manual were observed in the kitchen area.

Garage/Outdoor: The garage is kept unlocked at all times. The washer and dryer are located inside the garage. Cleaning supplies and disinfectants are stored in a locked cabinet inaccessible to clients. The backyard has a covered outdoor area equipped with furniture for client use. The side gates (2) were self-closing and latched. No bodies of water noted at the time of visit. Emergency water and food was observed at the time of the visit.

Continued on LIC 809 C

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2024
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. #2
FACILITY NUMBER: 198600370
VISIT DATE: 04/26/2024
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Continued from LIC 809

Restrooms: There are two (2) restrooms for client use. Restrooms were clean and sanitary and in operating condition with non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature was measured and in compliance between 105- and 120-degrees Fahrenheit at the time of the visit.

Bedrooms: There are three (3) client rooms. two (2) single occupancy and one (1) double occupancy rooms, which were furnished with appropriate linens and required furniture. Adequate lighting in all bedrooms was observed. Also, there is one (1) staff bedroom.

Records: The LPA reviewed client records at 11:07 a.m. and staff records at 11:33 a.m. The LPA reviewed four (4) client files for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, LIC627(c) Consent for Treatment form, and current needs and services plan. The LPA reviewed four (4) staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, and current first aid certification. All files were complete. The LPA also audited the current Administrator’s file, and it was in order. The facility is vendored by North Los Angeles County Regional Center (NLACRC) as a level 2 - home. The last disaster drill was conducted on 12/09/2023, LPA explained that per regulation, drills should be done quarterly and not every 6 months. Licensee will submit current drill to LPA. The LPA obtained the following documents: LIC500 Personnel Report, LIC9020 Client Roster, and liability insurance.

Medications: Medications review began at 11:54 a.m.; medications are centrally stored and locked in a file cabinet adjacent to the dining room. Medications are labeled and checked for expiration dates. One (1) out of four (4) clients currently taking medications. No errors observed during the medication review.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Valeria Conway
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC809 (FAS) - (06/04)
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