<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609836
Report Date: 10/10/2024
Date Signed: 10/10/2024 12:51:48 PM

Document Has Been Signed on 10/10/2024 12:51 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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:ALORA'S VILLAFACILITY NUMBER:
197609836
ADMINISTRATOR/
DIRECTOR:
DE MATA, EVANGELINEFACILITY TYPE:
740
ADDRESS:25043 GREEN MILL AVETELEPHONE:
(818) 634-9860
CITY:SANTA CLARITASTATE: CAZIP CODE:
91321
CAPACITY: 6CENSUS: 6DATE:
10/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Adam Maliwat & Evangeline DeMataTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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) Tuesday Cabiness conducted unannounced Annual Required inspection. LPA informed staff the purpose of the visit, who contacted the Administrator who arrived shortly after. LPA checked personnel summary report to verify fingerprint or association clearance, and it was observed all staff is cleared. The facility is licensed to serve for (6) elderly residents, age (60) and over. Currently the facility’s census is (6), with (2) residents on hospice. LPA observed facility license and sketch, emergency disaster plan, grievance/complaint procedures, personal rights, rights of resident council, resident bill of rights, and emergency disaster plan visibly posted on the wall; including COVID signs.

LPA toured the physical plant inside and outside with staff. LPA inspected resident bedrooms, bathrooms, and common areas, to ensure there were no health and safety hazards and facility is in compliance with Title 22 Regulations. The facility has (6) bedrooms, with (4) bathrooms. Inside temperature was comfortable, and LPA observed all areas to be clean and appropriately furnished for resident’s comfort and safety. LPA reviewed the food service and storage area, and it was observed to have a sufficient supply of perishable and nonperishable. The facility stores extra refrigerator in the garage, with fresh fruit, vegetables, and frozen meat. Storage areas for toxins, knives, and medication were locked and secured. Hot water temperature measured at 109.4 degrees Fahrenheit. Bathrooms are provided with soap, towels, non-skid mat, and grab bars were located by shower and toilet. Smoke and carbon monoxide detectors are hard-wired and were operating correctly. Fire extinguishers are fully charged. First aid kit had sufficient supplies including tweezers, scissors, thermometer and first aid manual. The backyard had clear passageways and free from obstruction, with gates easily accessible. Patio furniture area had comfortable table and chairs for residents.

LPA checked centrally stored records, and medication records, and observed client and staff files.

No Citation issued; exit interview and copy of report provided.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2024
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 1