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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608511
Report Date: 11/09/2024
Date Signed: 11/09/2024 03:17:10 PM

Document Has Been Signed on 11/09/2024 03:17 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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:CASA BLANCA HOMECAREFACILITY NUMBER:
197608511
ADMINISTRATOR/
DIRECTOR:
MARILOU A. ANDREASFACILITY TYPE:
740
ADDRESS:17216 GOYA STREETTELEPHONE:
(818) 366-2234
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 4CENSUS: 0DATE:
11/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:28 PM
MET WITH:Marilou AndreasTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the administrator, Marilou Andreas and explained the reason for the visit.

At approximately 12:30pm, with the assistance of the administrator, LPA took a tour of the physical plant. The facility is a two story building, but only the first floor is licensed for operation. Only the licensee/owner occupies the second floor. No residents are allowed on the second floor. Required postings were observed in the entry area. The smoke alarms are hardwired and interconnected. The carbon monoxide detector is located in the dining room area. The fire extinguisher is located in the kitchen.

Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives and cleaning supplies are being stored in locked drawers. Properly labeled medications were locked in one of the kitchen cabinets.

Bedrooms: There are three (3) bedrooms designated for residents' use. Two (2) bedrooms are for private use, and one (1) is shared. Bedrooms were properly furnished with appropriate beddings and linens with sufficient lighting.

Bathrooms: There is one (1) bathroom designated for the residents' use, which was observed to be properly supplied and had functional fixtures. Hot water temperature was measured at 114 degrees Fahrenheit. There were no cleaning supplies stored in the bathroom during the day's inspection.

Common Areas: These included the living room and dining area, which is next to each other. The common areas were properly furnished with a dining room table, large enough to seat six (6). The den has a recliner, long table and fireplace, which is non-functional but screened properly. No tools present. The auditory alarms on all exit doors were on and functional at the time of the visit.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2024
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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: CASA BLANCA HOMECARE
FACILITY NUMBER: 197608511
VISIT DATE: 11/09/2024
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Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor
use. The outdoor area was free of hazards. There is a swimming pool, which is properly fenced with a five foot gate enclosing it. There is a lock at the gate, making entry inaccessible for the residents to gain entry.

Garage: The garage is attached to the home. There is also an additional refrigerator for extra perishable food storage. PPE and cleaning supplies are maintained in the garage. Entry to the garage from the inside of the home is locked at all times, and requires a combination to unlock and gain entry.

Laundry: Washer/dryer for the laundry is in the garage.

Resident Files: Facility currently has no residents at this time.

Staff Files: LPA 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 kitchen cabinet designated to store and lock medications.

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: 11/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2024
LIC809 (FAS) - (06/04)
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