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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609055
Report Date: 10/04/2021
Date Signed: 10/04/2021 11:57:08 AM

Document Has Been Signed on 10/04/2021 11:57 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:SK MARATHON HOME CAREFACILITY NUMBER:
197609055
ADMINISTRATOR:KIM, SUN ILFACILITY TYPE:
740
ADDRESS:7246 FALLBROOK AVETELEPHONE:
(818) 912-6757
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY: 6CENSUS: 4DATE:
10/04/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Sun Kim/ AdministratorTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Jackson and Licensing Program Analyst (LPA) Shanahan arrived at the facility in order to conduct an annual infection control visit. LPAs were greeted by facility staff and after temperature checks were allowed to enter the facility. LPAs completed infection control tools and inspection.

The home was checked for fire safety and observed that the smoke alarms, carbon monoxide detector and all door alarms were functioning properly.

The facility is following their approved mitigation plan and no deficiencies were cited on today's visit.

Exit interview conducted and report issued.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Eleza Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2021
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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