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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191220719
Report Date: 08/29/2022
Date Signed: 08/29/2022 12:20:55 PM

Document Has Been Signed on 08/29/2022 12:20 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:BRU FAMILY HOME #2FACILITY NUMBER:
191220719
ADMINISTRATOR:LUIS BRUIFACILITY TYPE:
735
ADDRESS:528 EAST AVENUE J-10TELEPHONE:
(661) 949-6365
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 6CENSUS: 4DATE:
08/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Marie Bru, AdministratorTIME COMPLETED:
12:35 PM
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On 8/29/22, Licensing Program Analyst (LPA) Shira Stamps arrived at the facility for an unannounced one (1) year Required visit. LPA arrived at 10:45 am. LPA was greeted by a caregiver. LPA spoke to the Administrator over the phone and informed her of the purpose of the visit. The Administrator designated Lusia Pattriani to sign the report since she was out of town. The Administrator was able to arrive before the end of the inspection at 11:37am.
A tour of the physical plant was conducted with the Caregiver at 11:10 am. The facility has four (4) bedrooms and two (2) and bathrooms currently occupying four (4) clients. One (1) bedroom and one (1) bathroom is designated for staff use only. The facility is Fire Cleared for six (6) ambulatory.

Infection control: LPA reviewed the mitigation plan approved on 3/13/21. The facility is following current infection control recommendations. Upon arrival LPA was screened by the caregiver and asked all infection control questions. LPA was asked to sign-in and sanitizer was available.

Living and dining
At 11:10 am, LPA observed the living room and dining room to be neat and clean. The facility maintains a temperature of 72°F. The smoke detectors and carbon monoxide detectors were tested and observed to be operational at 11:31 am. LPA observed the locked filing cabinet storing client’s medications.

Food Inspection
LPA conducted a tour of the kitchen around 11:13 am and observed there to be sufficient stock of two-day perishables and seven-day non-perishables foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas care 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 05/10/22. CONTINUED...
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2022
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: BRU FAMILY HOME #2
FACILITY NUMBER: 191220719
VISIT DATE: 08/29/2022
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Bathrooms
LPA observed all bathrooms to have the appropriated wash your hands signs posted. Caregiver informed LPA the hot water went out this morning during showers, and the Administrator was notified. The Caregiver stated someone was coming by today to fix the hot water. Hot water was tested at 11:22am and measured at 79.0 degrees F. At 11:25am Romero the handyman arrived to fix the hot water.

Resident 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.

Laundry
The Laundry room is located in the hallway. LPA observed the locked closet to have chemicals/hazardous items, PPE supplies, and hygiene items.

Physical environment
LPA toured the outside area of the facility at 11:21 am. LPA observed a covered shaded area for clients. There are no bodies of water on the premises.

Administrative: Annual Fee is due. LPA collected the LIC 500 and Client Roster.

An exit interview was conducted, and a copy of this report was given to the Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022
LIC809 (FAS) - (06/04)
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