Facility Evaluation Report

Licensing Program Analyst (LPA) Brian Balisi conducted a pre-licensing visit to the above noted facility. The LPA met with applicant Katarina Boshoff. This is a change of location application from Montare on Vista #19760127 located at 18016 Valley Vista Encino CA 91316 to Montare at the Woodlands located at 5316 Lubao Ave #195850384 . The current capacity is for six (6) clients, the facility doesn't have any clients at this time. The fire clearance was granted for six (6) ambulatory clients.

The facility is two story. At approx. 10:30am, a physical plant tour was conducted inside and out. The facility has four (4) private resident bedrooms. Client room #1 has a direct exit to the outside. There are no fire sprinklers in the facility. All resident rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. In addition, no bedroom was used as a passageway to another room, bath or toilet. There is no staff room at the facility. For NOC , there will be awake night staff only. All rooms were free of odors. All window screens were clean and maintained in good repair.

There are five (5) bathrooms total. The resident bathroom(s) have a shower with non-skid materials. The toilet and shower have grab bars. The hot water temperature was tested in all the bathrooms and the kitchen and was found to be within the range of 105*F and 120*F.

Resident and staff records are to be stored in a cabinet in the office located across bedroom #4. Medications are to be centrally stored in a locked cabinet in the office as well. The first aid supplies were complete , including a thermometer and a current version of a first aid manual. First aid was stored inaccessible in the office.