197603946-9-9-2022-31-AS-SSTS-CJ4QGT-20220909121005

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197603946
Report Date: 09/09/2022
Date Signed: 09/09/2022 12:10:40 PM

Document Has Been Signed on 09/09/2022 12:10 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:	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:	09/09/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	David Taylor, Administrator		TIME COMPLETED:	12:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Shira Stamps met with administrator David Taylor for an unannounced one (1) year Required visit for this facility. LPA arrived at 10:35 am and was greeted by a caregiver. One (1) resident was observed in the living room watching TV. The rest of the residents were observed to be in their room sleeping, watching TV and/or resting. The Administrator arrived at 11:05 am. LPA informed the Administrator of the purpose of the visit. Infection control: LPA previously reviewed the facility mitigation plan (approved on 03/18/21) to make sure the licensee was following current infection control recommendations. Upon arrival LPA was screened by the caregiver and asked all infection control questions. LPA was asked to sign-in and sanitizer was available. A tour of the physical plant was conducted with Administrator at 11:10 am. The facility has four (4) bedrooms and two (2) bathrooms currently occupying six (6) residents. One (1) bedroom is designated for staff use only. The facility is Fire Cleared for four (4) ambulatory, two (2) non-ambulatory, and a hospice waiver for one (1). At this time the facility has no residents on hospice. Food Inspection LPA conducted tour of the kitchen around 11:12 am observed there to be sufficient stock of two-day perishables and seven-day non-perishables foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas care clean and inaccessible to pests. LPA observed all knives and sharp object being locked and inaccessible to residents in care. The Medication cabinet was located in kitchen and was observed to be locked and inaccessible to residents in care. CONTINUED...

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Shira Stamps	TELEPHONE: (818) 669-6375
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022

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: STRAWBERRY FIELDS	FACILITY NUMBER: 197603946
	VISIT DATE: 09/09/2022

NARRATIVE

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Resident Rooms
LPA observed rooms to have the appropriate bedding. There is a night stand and sufficient lighting for each client. LPA observed the staff room to have a locked filing cabinet for staff and residents’ files. Currently the staff office has an extra freezer, refrigerator, and PPE supplies.

Bathrooms
At 11:20 am LPA observed all bathrooms to have non-skid matts, grab bars, and the appropriated wash your hands signs posted. Hot water was tested and measured within regulation at 108.1 degrees F.

Living and dining
LPA observed the living room to be neat and clean along with the dining room. The facility maintains a temperature of 80°F. LPA observed all residents comfortable, wearing pants, sweaters or hats, and no residents seemed to be too warm. The dual smoke detectors and carbon monoxide detectors were tested and observed to be operational at 11:22 am. There are two (2) fire extinguishers, one (1) is located in the kitchen and one (1) is located in the hallway. The Fire extinguishers were observed to be full and last serviced on 09/02/22.

Laundry
LPA observed the laundry room to not have any chemicals or hazardous items.

Physical environment
LPA toured the outside area of the facility at 11:23 am. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. No bodies of water on the premises.

Garage
LPA observed no garage.

Administrative: Annual fee is current. LPA reminded the Administrator to maintain client and staff files. LPA requested the infection control plan.

An exit interview was conducted, and a copy of this report was given to the Administrator.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Shira Stamps	TELEPHONE: (818) 669-6375
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022

LIC809 (FAS) - (06/04)

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