197603946-5-7-2024-31-AS-LCAS-D52SDB-20240507134653

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197603946
Report Date: 05/07/2024
Date Signed: 05/07/2024 01:47:58 PM

Document Has Been Signed on 05/07/2024 01:47 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
WOODLAND HILLS S.RO, 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: 4	DATE:	05/07/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Monica Gory		TIME COMPLETED:	02:01 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) Lorena Casillas met with administrator Monica Gory for an unannounced one (1) year Required visit for this facility. LPA arrived at 09:50 am and was greeted by a caregiver. Caregiver called administrator and LPA was informed that administrator was on their way and would arrive in about an hour. 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 10:50 am. LPA informed the Administrator of the purpose of the visit. LPA was having technical difficulties with computer system and Inspection Tool Kit was not able to be completed. 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. A tour of the physical plant was conducted with caregiver at 10:20 am. The facility has four (4) bedrooms and two (2) bathrooms currently occupying four (4) 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). Currently the facility has no residents on hospice. Food Inspection: LPA conducted a tour of the kitchen at 10:20 am and observed there to be sufficient stock of two-day perishables and seven-day non-perishables foods. Frozen foods are properly wrapped and stored. Food storage and preparation areas are clean and inaccessible to pests. LPA observed all knives and sharp objects being locked and inaccessible to residents in care. The medication cabinet was in the kitchen and was observed to be locked and inaccessible to residents in care. Continued on LIC809-C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena Casillas	TELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: STRAWBERRY FIELDS	FACILITY NUMBER: 197603946
	VISIT DATE: 05/07/2024

NARRATIVE

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Resident Rooms: LPA observed rooms to have the appropriate bedding. There is a night stand, a chair 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 10:30 am LPA observed all bathrooms to have non-skid mats, grab bars, and the appropriate wash your hands signs posted. Hot water was tested and measured within regulation at 110.3 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 71°F. The dual smoke detectors and carbon monoxide detectors were tested and observed to be operational at 11:40 am. There are two (2) fire extinguishers, one (1) is in the kitchen and one (1) is in the hallway. The Fire extinguishers were observed to be full and last purchased on 10/29/2023.

Laundry: LPA observed the laundry room to not have any chemicals or hazardous items. Cleaning supplies are kept locked in a hallway closet outside of laundry room.

Physical environment: LPA toured the outside area of the facility at 11:00 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. LIC 500 and Client roster were collected. Liability insurance will be emailed to LPA today.

Resident Files: LPA conducted a file review of resident records at 11:45 am.

Staff Files: LPA conducted a file review of staff records at 12:45 pm.

Medications: At 1:30 pm LPA and caregiver reviewed medication and medication records.

No citations issued. Exit interview was conducted, and a copy of this report was emailed to the Administrator.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena Casillas	TELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024

LIC809 (FAS) - (06/04)

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