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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610702
Report Date: 03/12/2025
Date Signed: 03/12/2025 11:13:38 AM

Document Has Been Signed on 03/12/2025 11:13 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:A KIND HEART SENIOR CAREFACILITY NUMBER:
197610702
ADMINISTRATOR/
DIRECTOR:		SANCHEZ, KRISEYDAFACILITY TYPE:
740
ADDRESS:10541 DEBRA AVE.TELEPHONE:
(818) 458-6530
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 6CENSUS: 5DATE:
03/12/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Kriseyda & Hernan SanchezTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Michael Cava conducted a Pre-Licensing Inspection with the applicant representatives and administrators, Krisyeda and Hernan Sanchez. A Change in Owner Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on September 24, 2024. The facility is a one story building. A fire clearance was approved on December 17, 2024 for six (6) bedridden residents. The applicant is also requesting a hospice waiver to retain six (6) residents. The smoke alarms and carbon monoxide detector are dual and interconnected. The fire extinguisher is located in the kitchen. The charge date is February 3, 2025.

A tour of the physical plant was initiated and the following was observed:

KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, stove/oven, microwave oven and sink. There were adequate supplies of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). Knives were observed locked in a kitchen drawer.

BEDROOMS: There are five (5) bedrooms designated for client use. Per Fire Safety Inspection Request (STD 850), all bedrooms are clear for bedridden. Bedrooms #2 to #5 are private, and bedroom #1 is shared. The applicant furnished all the resident bedrooms with beds, night stand, chairs, dresser, bedding and linen. The bedrooms have sufficient lighting and closet space. Auditory alerts in bedrooms with direct exit were all tested functional.

BATHROOMS: The facility has two (2) full bathrooms and one (1) half bath. Bedroom #2 has a half bathroom which only consists of a toilet and sink The two full bathroom, designated for resident use are in the hallways. All bathrooms were observed to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured between 108 to 110 degrees.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: A KIND HEART SENIOR CARE
FACILITY NUMBER: 197610702
VISIT DATE: 03/12/2025
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COMMON AREAS: These included the living room and dining room area. The living room is furnished with a couch, five (5) recliners, table and television. Gas valve to fireplace is shut off, making it non-functional. Fireplace had a chain screen. The dining room table is large enough to seat up to six (6) residents. Auditory alerts in all exit doors were tested and functional. Cleaning supplies are kept in a locked closet by the living room.

Garage: The garage is attached to the home, but entrance is through the backyard. Garage is utilized as storage for extra food, emergency water supply, generator, PPE, and laundry. There were two refrigerators in the garage for perishable food items. Entry to garage has a combination lock

LAUNDRY ROOM: The laundry room is located in the garage.

MEDICATIONS: Medications are kept in a locked cabinet in the kitchen.

OFFICE/STAFF WORKSTATION/STAFF BREAKROOM: Staff Office/Work Station is located by the kitchen. Staff and resident files will be maintained there. Office/Workstation is kept locked. There is a staff break room, located by the living room

SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. Exterior gates at the front of the property has functional auditory alerts. The backyard of the facility has a patio and outdoor furniture to accommodate the six (6) residents. There is sufficient space in the backyard for outdoor activities. There is a swimming pool that is fenced all around with a gate that will be kept locked at all times. The fence surrounding the swimming pool is approximately 5 feet high, with a wall about ten feet high at the opposite end.

In addition to the Pre-Licensing inspection, a Component III power point presentation was also held.

Pursuant to Title 22, Division 6 of the CA Code of Regulations, the facility's physical environment is compliant and ready for licensure. CAB will be advised and a copy of this report provided.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC809 (FAS) - (06/04)
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