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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606597
Report Date: 11/10/2021
Date Signed: 11/10/2021 12:01:19 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:WESTPORT HOMEFACILITY NUMBER:
197606597
ADMINISTRATOR:RODA GARABATOFACILITY TYPE:
740
ADDRESS:10252 EAST AVENUE STELEPHONE:
(661) 944-5779
CITY:LITTLEROCKSTATE: CAZIP CODE:
93543
CAPACITY:20CENSUS: 11DATE:
11/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Roda Garabato - AdministratorTIME COMPLETED:
12:00 PM
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At 10:20 am, Licensing Program Analyst (LPA) Melissa Ruiz conducted an unannounced annual inspection at the facility mentioned above. LPA was greeted by Administrator Roda Garabato. This is a 10-bedroom, 5 bathroom two-story residential care facility for the elderly. A physical tour was initiated at 10:30 am and observed the following:

Infection control: One infection control sign was observed outside the facility. LPA reminded Administrator to place additional covid-19 signage outside the entrance. Upon entering the location, LPA observed the sign in station which contained thermometer, hand sanitizer, and visitors sign in sheet. LPA's temperature was recorded. Sufficient PPE supplies were observed. Food Inspection: LPA observed there to be sufficient stock of one-week non-perishable foods and two-day perishable foods. Food storage and preparation areas are clean and inaccessible to pests. Sharps and cleaning supplies are centrally stored in locked cabinets in the kitchen. Smoke detectors/carbon monoxide were located throughout the facility. Resident rooms: LPA was then escorted through the home and observed the resident’s rooms were properly furnished. Bathrooms: LPA observed the bathroom which contained wash your paper towels, hand sanitizer, and trash cans with closed tight-fitting lids. The water temperature read 120 F. Outside areas: LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There are no bodies of water.

No deficiencies cited. An exit interview was conducted. A copy of this report was provided.

SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa RuizTELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021
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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