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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600315
Report Date: 10/25/2023
Date Signed: 10/25/2023 11:23:07 AM

Document Has Been Signed on 10/25/2023 11:23 AM - 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:ESPERANCE CENTERFACILITY NUMBER:
191600315
ADMINISTRATOR:OBRADOVIC, STEVAN JAMESFACILITY TYPE:
735
ADDRESS:30711 MONTE LADO DRIVETELEPHONE:
(310) 457-1840
CITY:MALIBUSTATE: CAZIP CODE:
90265
CAPACITY: 6CENSUS: 5DATE:
10/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:James Obradovic, Administrator TIME COMPLETED:
11:50 AM
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At 09:45am, Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced annual inspection at the facility mentioned above. LPA was greeted by the Administrator, who granted access to the facility and LPA explained the reason for the visit. Physical tour was conducted with the Administrator and LPA observed the following:

Kitchen: At approximately, 09:55am LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps observed to be locked in a kitchen cabinet and inaccessible to clients in care. Fire extinguisher in the kitchen, was last serviced on 08/17/2023.

Medications: At approximately, 10:00am LPA observed medications are centrally stored and locked in the kitchen cabinet.

Bedrooms: There are three (3) bedrooms designated for clients use with sufficient lighting. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Facility has an awake staff

Bathrooms: At 10:15am LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and client's bathroom had non-skid mat. All trash cans in bathrooms had fitted lids to protect from cross contamination. Hot water temperature measured at 120°F.

Common Areas: The facility maintains a comfortable temperature at 73°F. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture and the

Continue on LIC9099-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2023
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: ESPERANCE CENTER
FACILITY NUMBER: 191600315
VISIT DATE: 10/25/2023
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fireplace is adequately screened. No obstructions and or tripping hazards throughout the facility. Laundry is located in the attached garage that can be accessed through the kitchen. LPA observed all detergents locked and inaccessible to clients in care. Extra PPE supplies and food storage was also observed.

Smoke detectors/carbon monoxide. Smoke detectors were located throughout the facility, and at 10:20am they were tested and observed to be operational. Carbon monoxide was located in a hallway and was also tested and observed to be operational.

Outside areas: At approximately, 10:25am LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. LPA discussed the importance of maintaining the care and supervision to meet the needs of clients.



Between 10:30am to 12:30am, LPA reviewed records of two (2) clients and two (2) staff. Client and staff records appeared to be complete and updated.

Administrative: LPA collected Certificate of Liability Insurance, and LIC.500.

No citations issued during this visit. Exit interview conducted. Copy of report emailed to the Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC809 (FAS) - (06/04)
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