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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610347
Report Date: 12/04/2024
Date Signed: 12/04/2024 12:33:25 PM

Document Has Been Signed on 12/04/2024 12:33 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:ELWOOD HOME CARE LLCFACILITY NUMBER:
197610347
ADMINISTRATOR/
DIRECTOR:		MANLAPAZ, EILEENFACILITY TYPE:
740
ADDRESS:4099 ELWOOD AVENUETELEPHONE:
(661) 526-5950
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY: 6CENSUS: 5DATE:
12/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Eileen Manlapaz-AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 12/04/2024 at approximately 09:44 am, Licensing Program Analyst (LPA), Angelica Segovia and Licensing Program Manager (LPM) Troy Agard conducted an unannounced annual visit to the facility. Upon arrival LPA was greeted by care giver Ruby Musni. LPA disclosed the reason for today’s visit. Caregiver Musni then called Administrator Eileen Maniapez who could not attend today’s visit but designated Assistant Administrator Alvin Maniapez to oversee today’s visit and sign any documentation's needed.

LPA asked for census, staff, and resident file. LPA conducted a physical plant tour at approximately 10:30 am and the following was noted:

There is only one entrance being utilized at the facility. The facility is a single unit building with four (4) bedrooms and two (2) bathrooms currently occupying five (5) residents. There is one (1) room located outside near room four (4) that is designated for staff use. The facility is fire cleared for six (6) non-ambulatory residents, one of which may be bedridden in room #4. Hospice waiver for three (3) residents.

Required postings such as Facility License, Facility Sketch, and Ombudsman were located at the main entrance. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available.

Common areas are neat, clean, and organized. Rooms are properly furnished and in good repair. Fireplace observed to be covered inaccessible to residents. The facility maintains a comfortable temperature at 69°F. Fire extinguisher located in the kitchen and was purchased on 10/15/24. Additional required postings were observed aside the common areas such as: Yes poster, Emergency/Disaster Plan, and Personal Rights. Along side the common areas heading towards the kitchen medication, resident, and staff files are kept locked and inaccessible to residents. (continued on LIC 809-C)
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
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: ELWOOD HOME CARE LLC
FACILITY NUMBER: 197610347
VISIT DATE: 12/04/2024
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The kitchen observed to be fully stocked with two (2) days perishable and seven (7) days non-perishable food. Kitchen observed to be clean and inaccessible to pests. Knives, sharps, and cleaning solutions are kept locked in a cabinet under the sink and inaccessible to residents. Stove observed to be working and in proper condition.

The backyard of the facility is equipped with a designated shaded area with outdoor furniture for residents. There is no body of water in this facility.

Smoke detectors and carbon monoxide observed to be working properly and were tested.

The Garage can be accessed from the inside of the facility. The garage is equipped with an extra refrigerator and fully stocked with food. Laundry room located inside the garage. Laundry detergents, cleaning agents, and other toxins are stored in the garage which is kept locked and inaccessible to residents.

The Residents' rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lighted appropriately. Residents have sufficient personal hygiene product which is provided by the licensee. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars in the toilets and showers. The hot water temperature was measured at a range of 107.6°F. Towels and washcloths are not shared. Sufficient availability of clean lien stored in hallway cabinet.

Medications: LPA observed medication stored in locked cabinet and inaccessible to residents. Medication usage recorded and stored properly. LPA along with Assistant Administrator Maniapez conducted a review of the medication to ensure compliance. First-aid kit observed to be equipped with but not limited to: bandages, scissors, digital thermometer, tweezer, and manual.

Resident records: LPA conducted a complete file review of resident records. Resident records appeared to be complete and updated. Staff records: LPA conducted a complete file review of staff records. Staff records appeared to be complete and updated.

There was no immediate health and safety hazard observed during the day of inspection. Exit interview conducted and a copy of this report was provided to facility representative, Alvin Maniapez.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
LIC809 (FAS) - (06/04)
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