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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005943
Report Date: 04/08/2021
Date Signed: 10/13/2021 10:36:13 AM

Document Has Been Signed on 10/13/2021 10:36 AM - 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:MANDEL HOUSEFACILITY NUMBER:
306005943
ADMINISTRATOR:MCDONALD, LISAFACILITY TYPE:
735
ADDRESS:2220 CONCORD STREETTELEPHONE:
(818) 782-2211
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY: 6CENSUS: 0DATE:
04/08/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Lisa McDonald, AdministratorTIME COMPLETED:
10:15 AM
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Licensing Program Analyst, Kathrina Chin contacted the facility via telephone and FaceTime App for a pre-licensing evaluation due to COVID-19 and for pre-cautionary measures. LPA Chin identified herself and spoke to Lisa McDonald, Administrator and Julie Ippoliti, Senior Director of Programs and discussed the purpose of the virtual visit. The facility has five bedrooms and three bathrooms and is a one story with a two car garage. This pre-licensing inspection is due to a change of ownership and the facility has no residents in care at this time. The inspection is as follows:

A fire clearance was granted on January 13, 2021 for 6 ambulatory. Hot water were tested in three bathrooms and observed to be between 106.8 F- 109.5 degrees Fahrenheit. Fire extinguisher was mounted and charged in the kitchen. Ms. McDonald indicated that a second fire extinguishers will be placed in the hallway. Smoke detectors and carbon monoxide detectors were centrally wired throughout, operational and have been checked by the fire department. There is a sufficient supply of linens. Bedrooms are appropriately furnished. There is sufficient lighting. There are non-skid mats in the showers.

There was one locked medication cabinet which stores one first aid kit. There is a locked cabinet for the knives in the kitchen. There were locked closets for storage of toxins, cleaning equipment, and hygiene items in the garage. The kitchen area was checked and there is a supply of food items. There were emergency food supplies and water. LPA observed activity calendars, complaint policy, resident rights and emergency plans were posted along with LIC 610D. LPA reviewed the outdoor area and observed outdoor furniture and an umbrella shade for residents in the front courtyard and the backyard has a patio for shade with outdoor furniture.

(Continued on LIC 809C)
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kathrina Chin
LICENSING EVALUATOR SIGNATURE: DATE: 04/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2021
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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: MANDEL HOUSE
FACILITY NUMBER: 306005943
VISIT DATE: 04/08/2021
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(Continued)

A Component III was completed on April 1, 2021 with Lisa McDonald, Administrator. LPA reviewed Personnel Policies, Prohibited Health Conditions, Fingerprinting, Abuse Reporting Procedures, In-Service Training and Medication Procedures.

It appears that this facility meets the requirements for licensure. Both the license will be granted upon final review and approval from the Central Applications Bureau.
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An exit interview was conducted with Administrator, Lisa McDonald and a hard copy of this report was provided via email for signature.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kathrina Chin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2021
LIC809 (FAS) - (06/04)
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