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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610701
Report Date: 02/28/2025
Date Signed: 02/28/2025 03:55:22 PM

Document Has Been Signed on 02/28/2025 03:55 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:INSTACARE, A PLACE CALLED HOMEFACILITY NUMBER:
197610701
ADMINISTRATOR/
DIRECTOR:		LOPEZ, MARLENFACILITY TYPE:
740
ADDRESS:344 E LAGO LINDO RD.TELEPHONE:
(818) 855-0377
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY: 6CENSUS: 0DATE:
02/28/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Christine Bwogi and Marlen LopezTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 2/28/2025 Licensing Program Analyst (LPA) Melissa Spaeth conducted an announced pre-licensing visit to this facility and met with the Applicant, Christine Bwogi and the Administrator Marlen Lopez. This is a new application. A fire clearance dated 11/27/2024 was received for six (6) non-ambulatory residents. Bedrooms 1, 2, 3, and 5 are designated to house one (1) non-ambulatory resident. Bedroom four is designated to house two (2) non-ambulatory residents.

The purpose of today’s visit is to inspect the facility to ensure that it maintains compliance under California Code of Regulations, Title 22, Division 6. Component III was conducted with the applicant and administrator from 9:40 am until 11:15 am.

Today’s site visit consisted of LPA touring the physical plant inside and outside from 11:20 am until 11:45 am. LPA Spaeth observed the following:

Office – The office contained a desk and a locked file cabinet. The staff and resident files will be locked in the cabinet.

Living Room– the living room contained comfortable seating.

Family room – The room contained comfortable seating.

Continued 809-C

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2025
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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: INSTACARE, A PLACE CALLED HOME
FACILITY NUMBER: 197610701
VISIT DATE: 02/28/2025
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Kitchen/Dining Room - The knives were locked in a kitchen cabinet. The facility contained a two-day supply of perishable food and a seven day supply of non-perishable food. A fire extinguisher is located in the kitchen area. The dining area contained a dining room table and chairs.

Laundry Room – A washer and dryer are located in the room. The resident medications will be locked in a cabinet. The laundry soap, first aid kit and cleaning solutions are locked in a cabinet.



Backyard - The backyard has a flower garden surrounded by comfortable seating. A shaded seating area is also available for residents. Also, there is a designated area for residents to plant their own garden.

Water Temperature - The water temperature was tested at 11:30 am and was 105.9 degrees F.

Bathrooms- The bathrooms contained hand soap, slip resistant mats, paper towels, grab bars and a trash can.

Bedrooms – The bedrooms contained bed, linens, night stand, chest of drawers, a chair, and a closet.

Hallway Closet - The hallway closet contained linens.

Garage – the garage was locked and is designated as a staff break room.

The smoke/carbon monoxide detectors were tested at 11:45 am and were operable. The facility was clean and appears to be in good repair.

This report will be forwarded to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025
LIC809 (FAS) - (06/04)
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