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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610490
Report Date: 09/09/2024
Date Signed: 09/09/2024 12:44:50 PM

Document Has Been Signed on 09/09/2024 12:44 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:ARCHWOOD ASSISTED LIVINGFACILITY NUMBER:
197610490
ADMINISTRATOR/
DIRECTOR:
ALINA SOLLOWAYFACILITY TYPE:
740
ADDRESS:17981 ARCHWOOD STREETTELEPHONE:
(747) 788-0208
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 6CENSUS: 4DATE:
09/09/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Alina Solloway,AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
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At 10:00 AM, Licensing Program Analyst (LPA) Huma Rahimi made a comprehensive Post Licensing visit to this facility and met with the Administrator Alina Solloway, and LPA explained the reason for the visit. During the time of the visit, LPA observed four (4) residents present at the facility.

LPA toured the physical plant areas outside and inside, the resident's four (4)bedrooms, three (3) bathroom and personal accommodation. LPA reviewed the food service areas and food supply (perishable & nonperishable) as well as received the residents and staff records. The storage of toxic and hazardous items were locked and inaccessible to residents in care. The medication were observed locked in a cabinet located in living room. The fire extinguisher was checked located in the kitchen and purchase on 10/18/2023, and the hot water temperature was measured in one of the bathrooms. The temperature measured at 108.9 degrees Fahrenheit in one of the bathrooms, which is the required range for residents comfort and safety. All required forms & poster were displayed on the facility's wall in the hallway adjacent to the laundry room. LPA observed the facility's temperature to be comfortable and was measured at 77 degrees Fahrenheit.

No citations were issued.


Exit Interview was conducted. Report was issued
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2024
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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