197603946-7-22-2021-31-AS-MSPH-C56V3H-20210722160445

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197603946
Report Date: 07/22/2021
Date Signed: 07/22/2021 04:05:21 PM

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:	STRAWBERRY FIELDS		FACILITY NUMBER:	197603946
ADMINISTRATOR:	DAVID JAMES TAYLOR		FACILITY TYPE:	740
ADDRESS:	434 E LANCASTER BLVD		TELEPHONE:	(661) 206-7925
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY:	6	CENSUS: 6	DATE:	07/22/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Julissa Dubon		TIME COMPLETED:	02:45 PM

NARRATIVE

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LPA Spaeth conducted an infection control visit with Caregiver Julissa Dubon at 2:00 pm. LPA observed the appropriate COVID-19 signs on the front door. Caregiver took LPA's temperature, asked COVID questions and requested LPA sign in. LPA observed sign in station with thermometer, hand sanitizer, and PPE supplies. LPA observed Caregiver wearing a mask.

LPA Spaeth confirmed there are six residents at the facility. LPA toured the two bathrooms and observed wash your hands sign, hand soap, trash can, and paper towels in the bathroom. LPA confirmed there are four bedrooms in the facility and observed all bedrooms contained beds, lamp, and lamp stand. Two residents were in room and LPA observed beds were 6 feet apart. LPA went to the backyard and observed comfortable seating. The gate at the side of the facility that leads from the backyard to the front yard was not locked.

LPA viewed the kitchen and saw the knives were locked in a kitchen drawer, cleaning supplies were locked under the sink, and there was a wash your hand sign paper towels, hand soap, and trash can. The pantry was adequately stocked with canned goods and pasta. The refrigerator was stocked with fresh vegetables and freezer contained a supply of frozen meats. LPA also observed the laundry room and observed there is a 6 month supply of PPE available for use.

There are no deficiencies to report at this time. Exit interview conducted, appeal rights discussed, and LPA stated will mail the signed copy of the report to the Administrator.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

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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