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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603595
Report Date: 09/06/2023
Date Signed: 09/06/2023 05:16:38 PM

Document Has Been Signed on 09/06/2023 05:16 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:PARKWOOD HOME LLCFACILITY NUMBER:
198603595
ADMINISTRATOR:VALDEZ, ABRAHAMFACILITY TYPE:
735
ADDRESS:301 PARKWOOD LNTELEPHONE:
(818) 240-4568
CITY:GLENDALESTATE: CAZIP CODE:
91202
CAPACITY: 5CENSUS: 4DATE:
09/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Jovanni Angeles, AdministratorTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced required one year annual inspection LPA met with Administrator Jovanni Angeles. LPA explained the purpose of the visit.

A tour of the physical plant was conducted at 2:30pm and the following was noted:

There is only one entrance being utilized at the facility The facility has four (4) bedrooms and three (3) bathrooms currently occupying six (4) residents. One room is shared and two rooms are private. One room is for staff.

Living and dining room furniture were also checked. The living room is neat and clean. The facility maintains a comfortable temperature at 76 degrees. The smoke detectors are observed to be operational. There is a carbon monoxide detector in the facility. Fire extinguishers are located in the kitchen and hallway and were last serviced on July 2023.

The backyard of the facility has outdoor furniture with a covered shaded area for residents. There is no body of water at the facility. There is also a garage with extra food and PPE supplies.

Laundry area is located in the garage, laundry detergents, cleaning agents and other toxins are stored in a closet which was observed to be locked.

Food Service/Kitchen area was sufficiently stocked with two (2) days of perishable and seven (7) days of non-perishable food. Knives and sharp objects were observed to be locked and inaccessible to residents.
The residents rooms are adequately furnished with appropriate furniture and lighting system.

Continue on 809-C
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2023
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: PARKWOOD HOME LLC
FACILITY NUMBER: 198603595
VISIT DATE: 09/06/2023
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The bathroom was checked for cleanliness and proper operation. . The hot water temperature was measured at 115.0 degrees. There was enough clean linen available in stock in the closet.

Medications-LPA observed medications to be locked and inaccessible to residents. There is one (1) complete first aid kit.

Exit interview conducted. A copy of this report was issued and signature obtained.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023
LIC809 (FAS) - (06/04)
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