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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603595
Report Date: 08/15/2022
Date Signed: 08/15/2022 04:11:55 PM

Document Has Been Signed on 08/15/2022 04:11 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:PARKWOOD HOME LLCFACILITY NUMBER:
198603595
ADMINISTRATOR:ANGELES, GIOVANIFACILITY TYPE:
735
ADDRESS:301 PARKWOOD LNTELEPHONE:
(951) 378-5150
CITY:GLENDALESTATE: CAZIP CODE:
91202
CAPACITY: 5CENSUS: 3DATE:
08/15/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Abraham Valdez and Giovani Angeles- ApplicantsTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Valeria Maldonado made an announced visit at the facility to complete the Pre-Licensing inspection. LPA Maldonado met with applicants Abraham Valdez and Giovani Angeles and explained the purpose of the visit. The building is a one story building, that is licensed to serve clients of ages 18 through 59 and has a capacity of 5, of which all are ambulatory.

During today's visit, an inspection of the physical plant was conducted by the applicants and LPA, which consisted of the following: the front of the home, dining room, kitchen, attached garage, common areas, client bedrooms, shared bathrooms, staff room, and laundry room. The facility building and grounds were free from hazards. All walkways were free from debris and/or obstructions.

Three client rooms were observed to have sufficient space to accommodate the resident's furnishings, and have all of the required furniture with plenty of personal storage space. Beds have the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. An adequate supply of linens were observed to be stored in the hallway linen closet.

Restroom (RR) #1 and #2 are designated for staff use. RR# 3 is a shared bathroom for client use. RR# 1- #3 were observed to have a working toilet, wash basin. RR# 2- #3 were observed to have working showers. Each bathroom was fully stocked with paper towels and soap for hand washing, and the water temperature in each bathroom measured within the required 105*F- 120*F degrees, per the California Code of Regulations- Title 22.

The facility has a telephone system is that is a landline and is operational, available for client use.


Report Continued on LIC809-C...
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Valeria Maldonado
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2022
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: PARKWOOD HOME LLC
FACILITY NUMBER: 198603595
VISIT DATE: 08/15/2022
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The Emergency Exit plan is posted and readily available for review near the facility entrance/exit. Fire extinguishers were located and mounted on the wall in the activity room, in the staff room, and in the kitchen. They were observed to be fully charged and have recent inspections.

Dishes, cups and flat ware are stored in the kitchen cabinets- inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are stored in a locked cabinet drawer next to the kitchen sink and under the sink. The food supply in the kitchen was observed to have the required 7-day non-perishable foods and 2-day of perishable foods available for the clients.

Smoke/carbon monoxide detectors were observed in each room in the facility and were tested and operational at the time of the visit. The facility also has an electrical and connected fire system that was tested and operational by the Glendale Fire Department on 06/09/22.

Stove burners, oven, microwave, washer, and dryer are working properly. There is one refrigerators located in the kitchen and one in the garage- used for extra food supplies. Each refrigerator has a measured temperature of at least 45*F for appropriate food storage and freezers are at 0*F. The facility is equipped with central air and heat and was at a comfortable 76*F during the time of the visit.

All poisons, toxins, and cleaning supplies are locked in a closet in the garage and in a locked cabinet under the kitchen sink- all inaccessible to clients in care.

The first aid kit was inspected and observed the have the required supplies and first aid manual to meet Title 22 Regulations. All staff and client files are kept in a locked cabinet in the living room. LPA also observed the central medication cabinet in the kitchen, locked and inaccessible to clients in care.

LPA Maldonado cleared the physical plant and conducted the Component III Orientation with the applicants.

An exit interview was conducted and a copy of this report has been furnished to the applicants.

Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Valeria Maldonado
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022
LIC809 (FAS) - (06/04)
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