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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425801652
Report Date: 08/26/2024
Date Signed: 08/26/2024 12:56:30 PM

Document Has Been Signed on 08/26/2024 12:56 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:SOLVANG FRIENDSHIP HOUSE-ADPFACILITY NUMBER:
425801652
ADMINISTRATOR/
DIRECTOR:		TAMMY WESTWOODFACILITY TYPE:
775
ADDRESS:880 FRIENDSHIP LANETELEPHONE:
(805) 688-8748
CITY:SOLVANGSTATE: CAZIP CODE:
93463
CAPACITY: 15CENSUS: 8DATE:
08/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Aisa CoronelTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 8/26/24 at 10:35 am, Licensing Program Analyst (LPA) Rankin conducted an unannounced Annual/Required visit to the facility listed above. LPA met with Aisa Coronel, Life Enrichment Day Program Coordinator, and explained the purpose of the visit.

LPA toured facility with the day program coordinator. The program is community based. The program site is clean, safe, sanitary and in good repair for the safety and well-being of clients, employees, and visitors. Facility is maintained in conformity with state fire marshal regulations. The smoke detectors and carbon monoxide detectors are hardwired. At 12:06 pm, hot water temperatures in the client bathroom measured 118.2 F. All toilets and hand washing facilities are maintained in a safe, sanitary, operating condition. Each client is accorded safe, healthful, and comfortable accommodations, furnishings, and equipment to meet their needs. Snacks, beverages, and meals are provided to clients. Food is stored and prepared in a safe and healthful manner. Fire extinguishers (3) are located in the large activity room near the kitchenette, in the kitchen, and in the hall near the laundry room. Extinguishers were fully charged and last inspected on 5/3/24. Facility temperature is 70 degrees.

Outdoor walkways are free from obstruction and the facility has fenced areas outside. Centrally stored medications are locked in a file cabinet in the coordinator’s locked office and inaccessible to clients. The Centrally Stored Medications are recorded and filed in a locked cabinet in the coordinator’s office. LPA observed sufficient staff to client ratio. Emergency disaster drills are being conducted quarterly and the last drill was on 7/30/24.


SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
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: SOLVANG FRIENDSHIP HOUSE-ADP
FACILITY NUMBER: 425801652
VISIT DATE: 08/26/2024
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LPA conducted a file review of five (5) clients. Client files reviewed had tuberculosis results, admission agreements and current needs and services plans. All files were updated with required documentation, annual assessments are documented and signed.

LPA conducted a file review of four (4) staff for criminal record clearances and associations, Health screening with TB results, current First Aid/CPR/AED, and adequate training hours. TB results and clearances/associations are completed. All files were updated with required documentation.

Exit interview conducted, and a copy of the report given.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC809 (FAS) - (06/04)
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