565850129-3-26-2024-29-AS-MARO-D3QUG6-20240326153350

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565850129
Report Date: 03/26/2024
Date Signed: 03/26/2024 03:34:14 PM

Document Has Been Signed on 03/26/2024 03:34 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	NEW LIFE GROUP HOME		FACILITY NUMBER:	565850129
ADMINISTRATOR:	MOSES T BAHINGIRE		FACILITY TYPE:	735
ADDRESS:	5642 EUNICE AVENUE		TELEPHONE:	(818) 324-9589
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93063
CAPACITY: 4		CENSUS: 4	DATE:	03/26/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Mac Turyeijuka / Cool Musinguzi		TIME COMPLETED:	03:40 PM

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Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced for a required one-year annual inspection today. The last annual conducted at this facility was on 02/10/2023. Upon arrival, the LPA was greeted at the door by staff, Mac Turyeijuka. The Administrator, Fatuma Nassanga was contacted via telephone, and at this time, the reason for the visit was explained. The Administrator was unavailable at the time of the inspection. Entrance interview conducted.

The LPA along with staff 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.

KITCHEN: The LPA inspected the kitchen/food service area at 1:56 p.m. Kitchen appliances appeared clean and were in operable condition at the time of the visit. The facility has a sufficient supply of perishable and non-perishable food. Refrigerator and food pantry were checked for proper labels and expiration dates.

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. The smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguisher was observed to be in compliance and last charged on 05/04/2023. The LPA observed required postings throughout the common space. There is a working telephone on premises. LPA observed medications, facility files, sharps and knives in the hallway closet locked and inaccessible to clients.

Continued on LIC 809C...

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024

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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: NEW LIFE GROUP HOME	FACILITY NUMBER: 565850129
	VISIT DATE: 03/26/2024

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Continued from LIC 809...

GARAGE/BACKYARD: The garage is attached to the facility. The washer and dryer were observed inside the garage. Staff take care of all client’s laundry needs. The facility has a sufficient amount of emergency food and water which was observed to be in good condition. The LPA observed a sufficient supply of Personal Protection Equipment (PPE). The backyard has a covered outdoor area equipped with furniture for client use. The facility has two (2) side gates that self-latch. All indoor and outdoor passageways were free from obstructions in case of an emergency. LPA observed a shed in the backyard with cleaning supplies and toxins locked and inaccessible. No bodies of water noted at the time of the visit.

BEDROOMS: There are four (4) single occupancy client bedrooms. Bedrooms appeared clean, well kept, with sufficient lighting and appropriately furnished.

RESTROOMS: There are two (2) resident restrooms. Restrooms were clean and sanitary and in operating condition with non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared. The hot water temperature was measured in both bathrooms, and they measured between 105.9- and 106.7-degrees Fahrenheit.

RECORDS: Records were not reviewed at the time of the inspection.

MEDICATIONS: Medications were not reviewed at the time of the inspection.

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

No deficiencies cited at this time. Exit interview conducted. Report was reviewed with staff, and copy of the report was provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2024

LIC809 (FAS) - (06/04)

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