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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609931
Report Date: 10/16/2024
Date Signed: 10/16/2024 02:32:45 PM

Document Has Been Signed on 10/16/2024 02:32 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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:KAREN'S BOARD AND CARE, INCFACILITY NUMBER:
197609931
ADMINISTRATOR/
DIRECTOR:		ZINKOFSKY, CLARITAFACILITY TYPE:
740
ADDRESS:17231 TUBA STREETTELEPHONE:
(818) 216-3271
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 6CENSUS: 6DATE:
10/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:07 AM
MET WITH:Brandon ZinkofslayTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
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On 10/16/24, at 11:07 am., Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, annual visit. LPA was met by Rose Panganiban. One (1) of the administrators was called and Brandon Zinkofslay-Administrator arrived at 12:30pm.

LPA asked for the census, resident, and staff rosters. At the entrance of the facility there is a sign for Resident Bill of Rights. There is also a staff, storage closet locked and inaccessible to residents.

The physical tour started at 12:10 pm. There is no garage but there is a carport area. There is also a shed in the backyard locked where there is extra wheelchairs and beds for residents. There is an extra refrigerator outside with extra food.

Backyard: There is a table set and chairs for residents use. There is enough seating for six (6) residents. There is a pool that is fenced and gated inaccessible to the residents.

Medications are in a cabinet locked and secured in the kitchen area. It is inaccessible to residents. The first aid is also located in this cabinet.



Kitchen area was observed to be clean. The refrigerator is fully stacked for six (6) residents. LPA reviewed the food service area, food storage and supply (perishable and nonperishable foods). The kitchen food supply was observed and sufficient for the six (6) residents currently residing there. There is an excess of perishables in several of the cabinets. The disaster plan is located against the wall in a frame on your right hand side of the kitchen area. In addition, there is the YES sign, Rights of Residents and Ombudsman signs. There is a fire extinguisher located in the kitchen against the wall, dated January 2024 and fully charged.

LIC 809C-continued
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: KAREN'S BOARD AND CARE, INC
FACILITY NUMBER: 197609931
VISIT DATE: 10/16/2024
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Living and dining room furniture is accessible for six (6) residents. There is a television and enough seating for six (6) residents. There is internet accessibility a phone line available for resident use. Furniture was observed to be in good condition and the fireplace has a covering around it.

There is a laundry area with one (1) washer and dryer. The toxins and sharps are kept on the side and on top of the laundry area locked and secured inaccessible to he residents.

There is smoke detectors and carbon monoxide detectors that are functional throughout the house.



Bedrooms: There is seven (7) bedrooms. Six (6) bedrooms are single, occupied for residents, One (1) bedroom is for staff use. There is three (3) bathrooms. Half bathroom used for staff and residents, one (1) private bathroom in a resident's room and one (1) full bathroom. The bathrooms read a temperature between 112.5 and 115.5 Fahrenheit. All bedrooms are properly furnished with proper lightning. The bathrooms have proper toiletry and grab bars. There are several extra closets in the hallway with extra linen.

Temperature of facility wall thermostat is observed and set to 73 degrees Fahrenheit.



Administrative: There is an annual fee due by December of 2024. The administrator showed proof of insurance plan.

An exit interview was conducted, no citation(s) issued and a copy of this report was given to the administrator

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024
LIC809 (FAS) - (06/04)
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