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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197605632
Report Date: 06/28/2022
Date Signed: 06/28/2022 12:11:55 PM

Document Has Been Signed on 06/28/2022 12:11 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:TURNER'S RESIDENTIAL FACILITYFACILITY NUMBER:
197605632
ADMINISTRATOR:VALEREE ZEPEDAFACILITY TYPE:
735
ADDRESS:2923 EAST AVENUE R-10TELEPHONE:
(661) 480-7297
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY: 4CENSUS: 4DATE:
06/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Valeree Zepeda, AdministratorTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Shira Stamps arrived at the facility for an unannounced one (1) year Required visit. LPA arrived at 10:10 am and knocked on the door but there was no answer. LPA called the Administrator at 10:19 am, and stated she was on her way over to the facility. The Administrator arrived at 10:40 am, and LPA informed the Administrator of the purpose of the visit.

A tour of the physical plant was conducted with the Administrator at 10:48 am. The facility has three (3) bedrooms and two (2) bathrooms currently occupying four (4) clients. One (1) bedroom and one (1) bathroom is designated for staff use only. The facility is Fire Cleared for four (4) ambulatory.

Infection control: LPA reviewed the mitigation plan approved on 2/20/21. The facility is 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.

Living and dining
At 10:52 am, LPA observed the living room to be neat and clean. The facility maintains a temperature of 73°F. The smoke detectors and carbon monoxide detectors were tested and observed to be operational at 11:00 am. LPA observed the client files and first aid kit located in the entry way.

Food Inspection
LPA conducted a tour of the kitchen around 10:48 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 appropriately. Food storage and preparation areas care clean and inaccessible to pests. There is one (1) fire extinguisher located in the kitchen. The Fire extinguisher was observed to be full and last serviced 10/12/21. The medication cabinet was observed to be locked in the kitchen.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: TURNER'S RESIDENTIAL FACILITY
FACILITY NUMBER: 197605632
VISIT DATE: 06/28/2022
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Bathrooms
LPA observed all bathrooms to have the appropriated wash your hands signs posted. Hot water was tested at 11:06 am and measured within regulation at 115.5 degrees F.

Resident Rooms
LPA observed rooms to have the appropriate bedding. There is a nightstand and sufficient lighting for each client.

Laundry
The Laundry room is located near the garage. The laundry room remains locked at all times and contains chemicals/hazardous items.

Garage
At 10:55 am, LPA observed the locked garage to be attached to the facility and is currently being used for storage, extra refrigerators, PPE supplies, knives and sharp objects, and chemicals/hazardous items.

Physical environment
LPA toured the outside area of the facility at 10:57 am. LPA observed a covered shaded area for clients. There are no bodies of water on the premises.

Administrative: Annual fee is current. The Administrator inquired about the due date of the infection control plan, and ways to submit the plan for approval. LPA provided the Administrator with the requested information.

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

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
LIC809 (FAS) - (06/04)
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