565801896-12-20-2023-29-AS-ECAS-CYPV9S-20231220151449

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801896
Report Date: 12/20/2023
Date Signed: 12/20/2023 03:16:39 PM

Document Has Been Signed on 12/20/2023 03:16 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	LAND OF ENCHANTMENT BOARD AND CARE		FACILITY NUMBER:	565801896
ADMINISTRATOR:	ROXANA LARA		FACILITY TYPE:	740
ADDRESS:	346 E. GAINSBOROUGH ROAD		TELEPHONE:	(805) 379-2185
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	6	CENSUS: 6	DATE:	12/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Administrator-Roxana Lara		TIME COMPLETED:	03:30 PM

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Licensing Program Analyst (LPA) Elsie Campos arrived at the facility unannounced to conduct a required annual visit at approximately 2:00 p.m. The LPA was greeted by staff and informed them of the reason for the visit. Administrator Roxana Lara arrived shortly thereafter.

The LPA and the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

BEDROOMS/BATHROOMS: Beginning at 2:15 p.m. the LPA inspected the bedroom and bathroom areas. Bedrooms were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. There are five (5) designated resident bedrooms. The three (3) resident bathrooms were clean, sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature measured between 104.1 and 116.6 degrees Fahrenheit in resident bathrooms.

KITCHEN: The LPA toured the kitchen/food service area. Knives and cleaning supplies are stored inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Food was observed to be of good quality.

COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. The facility maintained a comfortable temperature of 75 degrees F. Smoke detector(s) and carbon monoxide detector were tested at 2:45 p.m. and operational at the time of the visit. The single fire extinguisher was fully charged, and last purchased 10/2023. The LPA observed required postings throughout the common space. Medications are located in a locked closet at the entrance of the facility.

Continued on LIC 809-C

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LAND OF ENCHANTMENT BOARD AND CARE	FACILITY NUMBER: 565801896
	VISIT DATE: 12/20/2023

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OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for resident use. There is a side gate for emergency exit, resident use and is single latched. There is gated pool in the backyard that was locked and inaccessible at the time of the visit. Exits are free of obstructions. The garage is attached to the facility and access is through the kitchen. The washer and dryer are located in the garage, cleaning supplies and disinfectants are kept in locked in the garage. There is a sufficient supply of emergency food and water.

Due to time constraints, the LPA will return at a later date to complete the inspection.

The LPA obtained the following documents:

- LIC9020 Client Roster
- Liability Insurance

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

LIC809 (FAS) - (06/04)

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