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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603121
Report Date: 12/18/2023
Date Signed: 12/19/2023 07:53:53 AM

Document Has Been Signed on 12/19/2023 07:53 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:BRU JR FAMILY HOMEFACILITY NUMBER:
197603121
ADMINISTRATOR:BRU, LUIS JRFACILITY TYPE:
735
ADDRESS:1210 EAST DONATELLO STTELEPHONE:
(661) 945-7641
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: 4DATE:
12/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Luis Bru- AdministratorTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Mariana Agban conducted an Annual Required visit and inspection of the facility. LPA met with Administrator Luis Bru. At approximately 12:05 PM, with the assistance of the Administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are interconnected and battery-operated. There is a carbon monoxide detector that functions properly installed in the hallway. The fire extinguisher is located in the kitchen. The charge date is June 9,2023.
Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked closet in the staff room. Properly labeled medications were locked in a closet in the staff room.
Bedrooms: There were three (3) bedrooms designated for clients' use. All bedrooms, in use by clients,were properly furnished with appropriate beddings and linens with sufficient lighting.
Bathrooms: There is one (1) bathroom designated for clients' use. The bathroom was properly supplied and had functional fixtures. Hot water temperature was measured from the bathroom sink at 102.3 degrees Fahrenheit. No cleaning supplies or hazardous items were present in each bathroom during the inspection. Common Areas: These included the living room and dining area. The common areas were properly furnished. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. Laundry Area: is located in the garage,appliances observed to be in good repair. Laundry detergents are locked and thus they were inaccessible to clients. Clients Files: LPA conducted a file review of clients records to insure compliance of licensing forms. Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. Medications: Medication and Medication Records were review for proper documentation.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2023
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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