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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609055
Report Date: 10/06/2022
Date Signed: 10/06/2022 12:40:21 PM

Document Has Been Signed on 10/06/2022 12:40 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: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:
10/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Sara KimTIME COMPLETED:
12:49 PM
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At 11:35 p.m. on 10/06/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual visit. LPA met with Administrator and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out.

The facility was last visited on 06/13/2022 for a complaint visit. It is a single story building with 4 bedrooms, 2 bathrooms, kitchen, common areas, and outdoor areas. It has an approved fire clearance for 5 nonambulatory residents, of which 1 may be bedridden in Bedroom #3. Approved hospice waivers for 2. Cameras are used in common areas.

Upon entry, LPA a resident sitting outside in a maintained front yard. The front yard is gated. The ramp leading up to the main entrance was in good condition. Signs posted at the main entrance indicated the facility’s masking and visitation policies.

LPA was screened for infectious disease upon entry. The screening station contained a digital thermometer, surgical masks, sanitizing wipes, hand sanitizer, and a visitor log. The visitor log tracked temperatures, and the Administrator stated vaccination status and symptoms are documented and retained. Other postings inside included Ombudsman contacts, confidential complaint contact, personal rights, emergency contacts, rights of resident councils, COVID precautions, activity calendar, facility sketch, and facility menu.

Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. At 11:50 p.m. LPA measured the room temperature to be 79 degrees Fahrenheit. The fireplace was appropriately grated. Living room furniture was in good repair. Medications were locked near the dining room. 2 residents were observed eating lunch. LPA observed an adequate supply of perishable and non-perishable food in the kitchen. The stove hood was clean. Appliances were functional. Surfaces were sanitary. Sharps and cleaning solutions were locked above the counter top. Patio furniture was in good condition and shaded. The facility kept a pet dog outside. The laundry shed was behind the kitchen. It contained an operable washer and dryer, and detergents were locked in the shed.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2022
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: SK MARATHON HOME CARE
FACILITY NUMBER: 197609055
VISIT DATE: 10/06/2022
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The facility had 4 bedrooms. 1 was private and 2 were shared. 1 bedroom was designated for staff. The staff bedroom was free of hazards and inaccessible. All bedrooms contained a chair, nightstand, nightlights, storage, and bed with adequate bedding. All furnishings were clean and in good condition. Emergency exit paths were free from obstruction and unlocked. 3 out of 3 auditory alarms were on and functioning.

The facility had 2 bathrooms. All bathrooms contained liquid soap, paper towels, handwashing instruction sign, trash can with a tight fitting lid, grab bars near the toilet and shower, assistive devices, and a non-skid mat in the shower. At 11:56 a.m. LPA measured the water temperature in Bathroom #1 to be 116 degrees Fahrenheit.

At 11:59 a.m. LPA observed a fully charged fire extinguisher in the kitchen It was purchased on 01/02/2022. At 12:06 p.m. LPA tested the dual function smoke and carbon monoxide detector to be operational. 2 out of 2 detectors functioned simultaneously, and an additional verbal alert sounded.

During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC809 (FAS) - (06/04)
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