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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191291008
Report Date: 01/02/2024
Date Signed: 01/02/2024 02:31:29 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/02/2024 02:31 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:SPRING MEADOWS HOME IIFACILITY NUMBER:
191291008
ADMINISTRATOR:VON BUCK, DACIA L.FACILITY TYPE:
735
ADDRESS:44819 N. INOLATELEPHONE:
(661) 945-4990
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY: 4CENSUS: 4DATE:
01/02/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:26 PM
MET WITH:Richard HillTIME COMPLETED:
02:34 PM
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Licensing Program Analyst (LPA) Tihesha Smith made a subsequent visit to this facility at 1:26 pm to complete annual inspection from 12/10/2023. LPA disclosed to staff Richard Hill, the purpose of the visit. The administrator was not present in the facility. LPA Smith contacted the administrator and administrator authorized staff to sign report.

At 1:50 pm LPA reviewed staff records. Records contained current First aid and CPR and training's.

Smoke detectors/carbon monoxide detector were tested and operable at time of visit. However, smoke detector above administrator desk alarm was less audible than the hallway smoke detector. Staff to replace batteries-Technical advisory noted.

No Deficiencies cited.



Exit Interview/Copy of report issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE: DATE: 01/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/02/2024
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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