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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191220719
Report Date: 08/28/2024
Date Signed: 08/28/2024 01:17:43 PM

Document Has Been Signed on 08/28/2024 01:17 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 #2FACILITY NUMBER:
191220719
ADMINISTRATOR/
DIRECTOR:
LUIS BRUIFACILITY TYPE:
735
ADDRESS:528 EAST AVENUE J-10TELEPHONE:
(661) 949-6365
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 6CENSUS: 3DATE:
08/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Katherine Joy LaraTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Lorena Casillas arrived at the facility for an unannounced one (1) year required visit. LPA met with Back Up Administrator, Katherine Joy Lara.

LPA arrived at 09:30 am. LPA was greeted and given access by a staff member. LPA spoke to the Administrator over the phone and informed them of the purpose of the visit. The Administrator, Bibiana Lara Bru stated that they would not be able to meet with LPA however Back Up Administrator, Katherine Joy Lara would meet LPA to sign report.

A tour of the physical plant was conducted with Administrator at 10:50 am. The facility has four (4) bedrooms and two (2) and bathrooms currently occupying three (3) clients. One (1) bedroom and one (1) bathroom are designated for staff use only. The facility is Fire Cleared for six (6) ambulatory. One (1) client was present and observed watching TV in the living room, two (2) 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 10:50 am, LPA observed the living room and dining room to be neat and clean. The facility maintains a temperature of 74°F. The smoke detectors and carbon monoxide detectors were tested and observed to be operational at 11:20 am. LPA observed a locked filing cabinet storing client’s medications, staff and client records in the dining area.

Continued on LIC809-C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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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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 #2
FACILITY NUMBER: 191220719
VISIT DATE: 08/28/2024
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Kitchen: LPA conducted a tour of the kitchen around 10:55 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.

Bathrooms: LPA observed client bathroom to have the appropriate wash your hands signs posted. Hot water was tested at 11:05 am and measured at 108.5 degrees F.

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 and inaccessible to clients in care. Staff member was in the staff room during the visit.

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

Outside Area: LPA toured the outside area of the facility at 11:15 am. LPA observed furniture for clients to sit on, the umbrella was put away due to extremely high winds but there are large trees that provide shade. There are no bodies of water on the premises.

Administrative: Annual Fees are current. LPA collected LIC 500, Bond, Administrator Certificate and Client Roster.

Staff Files: LPA conducted a file review of staff records at 11:30 am. Resident Files: LPA conducted a file review of resident records at 12:00 pm.



Staff Interviews: At 12:45 pm LPA interviewed staff. Client Interviews: At 1:00 pm LPA interviewed client.

Medications: At 1:10 pm LPA and Administrator reviewed medication and medication records.

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

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC809 (FAS) - (06/04)
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