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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405801500
Report Date: 12/03/2024
Date Signed: 12/03/2024 01:08:47 PM

Document Has Been Signed on 12/03/2024 01:08 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:SACHELE SENIOR GUEST HOME III LLCFACILITY NUMBER:
405801500
ADMINISTRATOR/
DIRECTOR:		AURORA G. GALINATOFACILITY TYPE:
740
ADDRESS:1758 7TH STREETTELEPHONE:
(805) 534-9950
CITY:LOS OSOSSTATE: CAZIP CODE:
93402
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
12/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:07 AM
MET WITH:Aurura GalinatoTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Rankin arrived at 10:07 am to conduct a 1-year annual visit to the facility above. LPA met with Administrator Aurora Galinato and explained the purpose of the visit.

A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit:

Physical Plant & Environment Safety: The facility has 3 resident bedrooms, 2 bathrooms and currently occupies 4 residents. The facility has smoke and carbon monoxide detectors that were tested and working properly during visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The showers have non-skid mats or textured bottoms. The pathways are clear of any obstructions. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care locked under sink and in outdoor locked sheds. The facility has a fenced backyard for client use with plenty of shade. The facility has telephone and internet service for resident use. The fire extinguishers were charged and an appointment for inspection was scheduled for 12/3/24.

Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance which expires on 12/21/2024. The facility is approved for a capacity of 6. The fire clearance is granted for 6 Non-Ambulatory. Hospice is approved for 5.

Continued 809-C
Kelly BurleyTELEPHONE: (805) 562-0413
Melisa RankinTELEPHONE: (805) 635-4718
DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: SACHELE SENIOR GUEST HOME III LLC
FACILITY NUMBER: 405801500
VISIT DATE: 12/03/2024
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Personnel Records & Training: Staff files had current 1st Aid/CPR, file reviewed for required documentation, files were found complete. Administrator certificates expires 11/06/2025. Staff have annual training completed for all subjects/topics and hours for 2024.

Resident Records & Incident Reports: Facility does submit incident reports to the department when required. LPA reviewed 4 resident files, ensured updated Appraisals Needs and Services Plan were documented and all other required documents were available, all records were in compliance.

Food Service: The facility handles and prepares food safely. The facility has 2-day perishables and 7-day non-perishables and plenty extra, to meet the food service requirement. All food is covered, stored, and marked appropriately. Food, snacks, and drinks are available when the residents want them. Facility is reviewing dry good storage regularly to ensure it is free of expired items. Cleaning solutions and equipment are stored separately from food supplies.

Incidental Medical Services: Facility provides assistance in arranging transportation to medical and dental appointments when needed. Residents have on-call Doctor that visits facility. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed and discussed residents’ medications, medication practices and documentation are in complaisance.



Disaster Preparedness: The current emergency disaster form was reviewed and discussed with administrator. The facility conducts quarterly disaster drills. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency.

Residents with Special Health Needs: The facility does accept dementia residents in care. The facility has 3 gates, each in good repair. Facility currently has two residents on oxygen. The facility currently has 1 hospice resident in care. The facility does not currently have any residents receiving Home Health services. The facility does not have delayed egress, locked doors or gates.

Exit interview conducted and copy of report printed for Administrator.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Melisa RankinTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC809 (FAS) - (06/04)
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