<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197605954
Report Date: 09/12/2023
Date Signed: 09/12/2023 12:55:57 PM

Document Has Been Signed on 09/12/2023 12:55 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:WATKINS RCFEFACILITY NUMBER:
197605954
ADMINISTRATOR:DAISY HAILEYFACILITY TYPE:
740
ADDRESS:42849 SACHS DRIVETELEPHONE:
(661) 718-8411
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 5CENSUS: 0DATE:
09/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Edna WatkinsTIME COMPLETED:
01:10 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) Evelin Rios in conjunction to complaint control number #31-AS-20230601085324 conducted an unannounced case management visit at this facility for closure. LPA explained to licensee the purpose of this visit is to confirm and document the closure of this facility and ensure all residents have been relocated.

The facility closure was initiated by the licensee. The licensee notified Community Care Licensing Division (CCLD), on 08/16/23 that the licensee intends to close the facility. On 08/31/23 CCLD received copies of two (2) 60-day eviction notices provided to two (2) residents residing in the facility at the time. On 08/31/23 one (1) resident had transferred to another licensed facility, Lancaster Haven RCFE - 197608302 and on 09/11/23 licensee notified LPA Rios last resident had moved out with their relative on 09/10/23.

Upon entrance at 9:15 a.m., LPA was greeted by Licensee Edna Watkins and granted access. Edna informed LPA they would like to move forward with closing the facility. LPA conducted a walk through of physical plant of the facility. LPA toured the backyard and observed two large sheds filled with licensee's personal items. LPA toured the inside of the facility and observed all bedrooms except for one to be filled with licensee's personal items. LPA observed one (1) room with an uncovered mattress and bed frame, empty dressers and closet. LPA observed there were no residents within the rooms. LPA observed bathrooms with licensee's personal items. LPA observed there were no residents in the garage. LPA did not observe residents' medication during tour. According to licensee residents have taken all their personal belongings including their medication. Licensee provided LPA with facility license.

LPA confirmed that this facility has ceased operation as of 09/12/23.

Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2023
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 1