Heavenly Home Care

Type of visit: Case Management - Other

At 9:30 AM, Licensing Program Analyst (LPA) Evelin Rios conducted a Case Management visit to confirm the closure of this facility. LPA contacted the licensee representative, Yayineabeba Assefa via telephone. LPA emailed the licensee and informed them LPA was at the facility. Licensee emailed LPA that they were no longer in control of the property and the facility was now a private residence. LPA received notification of facility closure on 08/08/2025 with effective closure date 10/08/2025. Licensee confirmed residents were notified of forfeiture. During the visit LPA rang the door bell. LPA confirmed this is a private residence, there were no residents residing in the facility and the licensee had ceased operation. The reason for closure of the facility is licensee initiated. Licensee was informed to mail License to the Regional Office. LPA will submit the file for closure upon returning to the Woodland Hills South Regional Office. LPA will e-mail the closure survey. Exit Interview conducted and copy of this report emailed for signature.the state’s words, verbatim · CDSS document, Jan 23, 2026

Type of visit: Required - 1 Year

On 12/09/2024 at 9:30 a.m., Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced Required Annual Inspection at the facility mentioned above. LPA was greeted by staff #1 (S1) who granted access. S1 requested LPA wash hands before continuing into the home. S1 contacted the administrator. House manager Lena Johnson met LPA at approximately 9:43 a.m. LPA explained the reason for the visit. The facility is licensed for three (3) ambulatory, three (3) non ambulatory of which one (1) may be bedridden with a total capacity of six (6) residents. Facility has a Hospice wavier for two (2). The inspection tool was used to complete the visit. A physical tour was conducted at approximately 9:45 a.m. along with the house manager and LPA observed the following: Entrance: LPA observed proper postings along a wall by the first living room and dining table. LPA observed hand sanitizer and masks were available. The fire extinguisher was observed by the front door with a purchased date of on 12/05/2024, fully charged. A second was by the kitchen with same purchase date. Common Areas: These include the dining area, and living rooms. All common areas were observed well lit, clean and clear of clutter. Furniture appeared clean and in good repair. There is a fire place properly secured with a screen. Kitchen: LPA observed the kitchen to be clean and clear of clutter. All appliances were operative. Knives are kept locked in a kitchen drawer inaccessible to residents. LPA observed there to be sufficient supply of 7-day non-perishable foods and 2-day perishable foods; properly stored. Bedrooms: There are four (4) bedrooms designated for resident use. One (1) out of four (4) bedrooms is a shared. Continued to LIC809-C) (Continued from LIC809) All resident rooms are furnished with required lighting, dresser, chair, bed, linens, and closets for storage. LPA observed a hallway closet with extra linens. Bathrooms: There are three (3) bathrooms designated for resident use. One (1) bathroom is located in the shared bedroom for private use. All bathrooms were clean, had grab bars, had non-slip mats, and trash bins with lids. LPA observed a sufficient supply of hand soup, toilet paper, and paper towels. At approximately 9:50 a.m. hot water temperature in one (1) bathroom was measured at 116.5°F, with regulation. LPA observed dual smoke and carbon monoxide alarms through out the facility, they are interconnected and hard wired. At approximately 9:58 a.m. the house manager tested the smoke alarms and they were observed functioning properly. Laundry Room/Garage: Laundry room is kept locked. LPA observed a washer and dryer that appeared operative. Through the laundry room is the door to the garage. The garage is used for facility storage. Surrounding Grounds: There were no visible hazards, and passageways were free from obstruction. There is appropriate outdoor seating for residents and a large umbrella to provide shade. Resident and Staff Files: At approximately 10:20 a.m. LPA conducted a file review of two (2) out of two (2) resident's files. LPA reviewed resident records to insure compliance of licensing forms. Administrator, Yayineabeba Assefa arrived at 10:24 a.m., LPA also conducted a staff file review at 10:48 a.m., of three (3) staff records to insure forms and training are up to date and compliance with licensing forms. Medications: LPA observed, resident medications and resident files locked in a closet inaccessible to residents. Facility keeps a medical administration record (MAR) with updated doctor orders on file. LPA observed a first aid kit in the same closet. At approximately 11:00 a.m. LPA and administrator reviewed centrally stored medication records and medication. LPA reviewed facility's fire drills, disaster training and discussed facility's liability insurance and infection control plan. No deficiencies were observed during todays visit. Exit interview conducted and a copy of this report issued.the state’s words, verbatim · CDSS document, Dec 9, 2024

Type of visit: Required - 1 Year

On 03/04/2024 at 9:20 a.m., Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced Required Annual Inspection at the facility mentioned above. LPA was greeted by staff #1 (S1) who granted access. Administrator Yayineabeba Assefa met LPA shortly after. LPA explained the reason for the visit. The facility is licensed for 3 non ambulatory and 1 bedridden with a total capacity of six (6) residents. Facility has a Hospice wavier for 2. The inspection tool was used to complete the visit. A physical tour was conducted at approximately 11:40 a.m. along with the administrator and LPA observed the following: Entrance: LPA observed proper postings along a wall by the first living room and dining table. LPA observed hand sanitizer and masks were available. The fire extinguisher was observed by the front door with a purchased date of on 11/15/2023 fully charged. Common Areas: These include the dining areas, and living rooms. All common areas were observed well lit, clean and clear of clutter. Furniture appeared clean and in good repair. There is a fire place not in use properly secured with a glass screen. Kitchen: LPA observed the kitchen to be clean and clear of clutter. All appliances were operative. Knives are kept locked in a kitchen drawer inaccessible to residents. LPA observed there to be sufficient stock of 7-day non-perishable foods and 2-day perishable foods. A 2nd fire extinguisher was observed by the back patio sliding door with a purchased date of on 11/15/2023. Bedrooms: There are four (4) bedrooms designated for resident use. Two (2) out of the four (4) rooms are currently vacant. One (1) out of four (4) is a shared bedroom with only one occupant. All resident rooms are furnished with required lighting, dresser, chair, bed, linens, and closets for storage. LPA observed a hallway closet with extra linens. (Continued to LIC809-C) LPA observed dual smoke and carbon monoxide alarms through out the facility, they are interconnected and hard wired. At approximately 10:00 a.m. the administrator tested the smoke alarms were observed functioning properly. Bathrooms: There are three (3) bathrooms designated for resident use. One (1) bathroom is located in the shared bedroom for private use. The other two (2) bathrooms are accessible to all the residents. All bathrooms were well lit, clean, had grab bars, had hand washing signs and trash bins with lids. LPA observed a sufficient supply of hand soup, toilet paper, and paper towels. At approximately 10:03 a.m. hot water temperature in the one (1) out of the three (3) bathrooms was measured at 116.5°F. Laundry Room/Garage: Laundry room is kept locked. LPA observed a washer and dryer that appeared operative. Through the laundry room is the door to the garage. The garage was observed to store the cleaning supplies, and extra water. Surrounding Grounds: There were no visible hazards, and passageways were free from obstruction. There is appropriate outdoor seating for residents and a large umbrella to provide shade. Medications/ Resident file: At approximately 10:10 a.m. LPA observed, resident medications and resident files locked in a closet inaccessible to residents. Facility keeps a medical administration record (MAR) with updated doctor orders on file. LPA observed a first aid kit in the same closet. At approximately 10:40 a.m. LPA conducted a file review of two (2) out of two (2) residents. LPA reviewed resident records to insure compliance of licensing forms. Staff Files: At approximately 11:00 a.m. LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. No deficiencies were observed during todays visit. Exit interview conducted and a copy of this report issued.the state’s words, verbatim · CDSS document, Mar 4, 2024

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.