<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191220619
Report Date: 12/10/2024
Date Signed: 12/10/2024 12:11:07 PM

Document Has Been Signed on 12/10/2024 12:11 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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:BRU FAMILY HOME #1FACILITY NUMBER:
191220619
ADMINISTRATOR/
DIRECTOR:		LETITIA RAMIREZFACILITY TYPE:
735
ADDRESS:639 EAST AVENUE J-10TELEPHONE:
(661) 945-5057
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 6CENSUS: 5DATE:
12/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Marie Lara BruTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Lorena Casillas arrived at the facility for an unannounced one (1) year required visit. LPA met with Administrator/Licensee Marie Lara Bru.

LPA arrived at 09:15 am. LPA was greeted and given access by Administrator. LPA explained the reason for the visit.

A tour of the physical plant was conducted with Administrator at 09:45 am. The facility has four (4) bedrooms and two (2) and bathrooms currently occupying five (5) clients. One (1) bedroom and one (1) bathroom are designated for staff use only. The facility is Fire Cleared for six (6) ambulatory. All clients were at day program.

Infection control: LPA reviewed the mitigation plan approved on 3/13/21. The facility is following current infection control recommendations.

Living and dining: At 09:50 am, LPAs observed the living room and dining room to be neat and clean. The facility maintains a temperature of 71°F. The smoke detectors and carbon monoxide detectors were tested and observed to be operational at 09:55 am. LPAs observed the locked filing cabinet storing client’s medications, staff and client records.

Kitchen: LPA conducted a tour of the kitchen around 10:00 am and observed there to be sufficient stock of two-day perishable and seven-day non-perishable foods. Frozen foods are properly wrapped and stored. Food storage and preparation areas are clean and inaccessible to pests. The knives and sharp objects are kept in the locked staff room. There are two (2) fire extinguishers located in the kitchen and the hallway. The Fire extinguishers were observed to be full and last serviced 04/24/2024.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: BRU FAMILY HOME #1
FACILITY NUMBER: 191220619
VISIT DATE: 12/10/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Bathrooms: LPA observed client bathroom to have the appropriate wash your hands signs posted. Hot water was tested and measured at 114.8 degrees F.

Rooms: LPA observed rooms to have the appropriate bedding. There is a nightstand and sufficient lighting for each client. LPA observed the staff room to be locked and inaccessible to clients in care. Staff member was in the staff room during the visit and allowed LPA entry.

Laundry: The laundry room is located in the hallway. LPA observed detergents to be locked in staff room and inaccessible to clients. Toiletries are located in the converted garage storage room.

Outside Area: LPA toured the outside area of the facility at 10:15 am. LPA observed furniture for clients to sit on, the umbrella was put away due to extremely high winds. There are no bodies of water on the premises.

Administrative: Annual fees is not current. LPA provided PIN and Administrator stated that fee would be paid by tomorrow 12/11/24. Administrator will call LPA with confirmation number. LPA collected LIC 500, Bond, Administrator Certificate and Client Roster.

Staff Files: LPA conducted a file review of staff records at 10:40 am.



Client Files: LPA conducted a file review of client records at 11:05 am.

Staff Interviews: At 11:45 am LPA interviewed staff present.

Client Interviews: All clients at day program, no client interviews were held.

Medications: At 12:00 pm LPA and Administrator reviewed medication and medication records for proper documentation.

No citations issued. Exit interviewed conducted and a copy of the report was given to the Administrator.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2