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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801896
Report Date: 01/09/2024
Date Signed: 01/09/2024 02:46:14 PM

Document Has Been Signed on 01/09/2024 02:46 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 N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:LAND OF ENCHANTMENT BOARD AND CAREFACILITY NUMBER:
565801896
ADMINISTRATOR:ROXANA LARAFACILITY TYPE:
740
ADDRESS:346 E. GAINSBOROUGH ROADTELEPHONE:
(805) 379-2185
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY: 6CENSUS: 5DATE:
01/09/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator-Roxana LaraTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elsie Campos arrived at the facility unannounced to conduct a continuation to a required annual visit at 10:00 a.m. The LPA was greeted by staff and informed them of the reason for the visit. Administrator Roxana Lara arrived shortly thereafter.

MEDICATIONS: Medications review began at 10:30 a.m.; medications are centrally stored and kept locked in
the medication closet located at the entrance of the facility. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review.

RECORDS: Residents’ records review began at 12:30 p.m., records were reviewed for, but not limited to care
plans, medical records, admissions agreement, consent forms. All records were in order.
Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first
aid/CPR training, and the appropriate training. All files were in order.

INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19.

Exit interview was conducted. No deficiencies cited at this time. A copy of the report was provided.
SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Elsie Campos
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2024
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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