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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 567609958
Report Date: 02/17/2023
Date Signed: 02/17/2023 04:06:16 PM

Document Has Been Signed on 02/17/2023 04:06 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:TREMONT HOME CARE, INC.FACILITY NUMBER:
567609958
ADMINISTRATOR:GRAHAM, LISAFACILITY TYPE:
735
ADDRESS:6694 TREMONT CIRCLETELEPHONE:
(805) 553-8451
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY: 6CENSUS: 3DATE:
02/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Lisa GrahamTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA), Martha Arroyo arrived unannounced to conduct a Required 1-Year Annual with focus on Infection Control. The last Annual conducted at this facility was on 03/25/2022. Upon arrival, the LPA met with Administrator Lisa Graham and the reason for the visit was explained. Entrance Interview.

The LPA along with the Administrator began the physical plant tour of the common areas, kitchen area, client bedrooms, bathroom, garage, and outdoor area to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The LPA observed one (1) client bathroom. Hot water temperature was measured for compliance and it measured at 108 degrees Fahrenheit. The LPA observed an adequate amount of perishable and non-perishable food. At 3:04 pm, the smoke detectors and carbon monoxide detectors were tested and operable. LPA observed medications locked in a cabinet adjacent to the living room. Sharps and knives were observed locked under the kitchen island. LPA observed Emergency food and water supply. Cleaning supplies and toxins were observed in the garage locked and inaccessible to clients. The living areas and dining areas are clean and properly furnished. LPA observed outdoor grounds with clear passageways and one (1) self-latching gate clear of obstruction for emergency use. No bodies of water observed at the time of visit. During today's visit, the LPA spoke with the Administrator regarding the facility's infection control practices. The facility has a central entry point for symptom screening, temperature checks, and sanitation station. The LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVlD-19. All staff are fully vaccinated. No identified staffing concerns.

Exit interview conducted. No citations issued. Report was reviewed and issued to Administrator.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2023
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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