197601724-5-29-2024-31-AS-MCAA-D5QPWQ-20240529114108

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197601724
Report Date: 05/29/2024
Date Signed: 05/29/2024 11:45:43 AM

Document Has Been Signed on 05/29/2024 11:45 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:	RINALDI GUEST HOME		FACILITY NUMBER:	197601724
ADMINISTRATOR/ DIRECTOR:	MARILYN ACABAL		FACILITY TYPE:	740
ADDRESS:	16016 RINALDI STREET		TELEPHONE:	(818) 831-6602
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY: 6		CENSUS: 6	DATE:	05/29/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:17 AM
MET WITH:	Clyde Acabal		TIME VISIT/ INSPECTION COMPLETED:	11:45 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the assistant administrator, Clyde Acabal and explained the reason for the visit. At 09:25am, with the assistance of staff, LPA took a tour of the physical plant. The facility is a one story building that houses level 4C elderly clients. Required postings were observed in the entry area. The smoke alarms are hard wired and battery operated. Pull chord to alert the fire department is also active. The carbon monoxide detector is located in between rooms #1 and #2. There are two (2) fire extinguishers, located in the kitchen and lounge. The last fire drill was held on 05/08/24 and the last earthquake drill on 04/05/24. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food sealed and properly stored. Knives and cleaning supplies were locked and inaccessible during the visit. Bedrooms: The facility has six (6) bedrooms. Rooms #1 and #3 are private. Rooms #5 and #6 are shared. Rooms #2 and #4 are reserved for staff. The bedrooms designated for resident use were observed to be properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are four (4) bathrooms designated for both resident and staff use. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured between 108 and 111 degrees Fahrenheit. No cleaning supplies were observed in any of the bathrooms Common Areas: These included the living room, lounge and dining area. The living room is furnished with two couches, chair and tv. The dining room table is large enough to seat six individuals. The lounge is located by rooms #4 and #5. The lounge had two couches and a tv. Floors were mopped and clean. Exits and passageways were clear of obstruction.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

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

FACILITY NAME: RINALDI GUEST HOME	FACILITY NUMBER: 197601724
	VISIT DATE: 05/29/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Surrounding Grounds: Entry/exits to the front and back of the home were free of obstruction. The patio at the backyard had furniture appropriate for outdoor use. There is a locked storage space in the patio area for an additional supply of non-perishable food. Ramps and rails were checked to be installed firm and in place. There is also a locked storage space for cleaning supplies in the backyard.

Garage: The garage is not attached to the building. It is located at the backyard of the home. The garage is used for additional storage space for medical and PPE supplies. The garage is locked and inaccessible to the clients.

Laundry area: The laundry area is located adjacent to the kitchen. Toxins and detergents not present at this time.

Staff Workstation/Office: There is a staff workstation located by the laundry area where client and staff records are kept.

Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

Medications: There is a medication cart stationed in the dining room. The cart was locked. Medication and Medication Records were reviewed for storage and proper documentation.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2