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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197605589
Report Date: 03/29/2022
Date Signed: 04/01/2022 11:19:38 AM

Document Has Been Signed on 04/01/2022 11:19 AM - 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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:RAWATES INC.FACILITY NUMBER:
197605589
ADMINISTRATOR:SUJATA RAWATEFACILITY TYPE:
735
ADDRESS:20131 LABRADOR STREETTELEPHONE:
(818) 718-7806
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY: 5CENSUS: 5DATE:
03/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Sujata Rawate TIME COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Joscelyn Martinez arrived at the facility to conducted an unannounced annual inspection. Upon arrival LPA was greeted by staff and LPA’s temperature was taken. LPA Martinez later met with Administrator Sujata Rawate. This is a level four (4) care facility. At 9:20 a.m. a physical tour of the facility was conducted and the following was observed:

Infection Control: Covid-19 infection control signage were observed outside of the facility. Proper signage was also observed inside in the common areas. Facility has sufficient PPE supplies for more than 30 days. High traffic areas are cleaned and sanitized frequently. Food Inspection: LPA observed there to be sufficient stock of one-week non-perishable foods and two-day perishable foods. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers in the kitchen. Sharps, cleaning supplies and medications are centrally stored in a locked area. Smoke detectors/carbon monoxide are located throughout the facility and are hardwired. Smoke detectors and carbon monoxide detectors were tested at approximately 10:17 a.m. and appear to be functional. Fire extinguisher has a service date of 03/03/2022. Common Areas: All common areas were observed to be clean and properly furnished. Facility maintains a comfortable temperature of 72.0 F. Clients Rooms: Facility has five (5) bedrooms all designated for client use. All five (5) bedrooms were toured and appear to be clean and properly furnished. LPA observed additional bedding and linens sufficient for all of the clients. Towels are not shared. All rooms have adequate lighting. Bathrooms: There are three (3) bathrooms in the facility. LPA observed all bathrooms to have grab bars and non-skid mats. At 10:10 a.m. the hot water was tested and measured at 106.5 F. All trash cans located in the bathrooms had tight fitting lids. Garage: There is a detached garage in the back of the house that is maintained locked and inaccessible to clients. Garage is used for storage and additional emergency food supplies.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Joscelyn Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2022
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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: RAWATES INC.
FACILITY NUMBER: 197605589
VISIT DATE: 03/29/2022
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Outside Area: LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There are no bodies of water. There is attached laundry area that is only accessible by the outside of the house and is maintained inaccessible to clients.

No deficiencies cited at this time. Exit interview conducted. Report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Joscelyn Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022
LIC809 (FAS) - (06/04)
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