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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606814
Report Date: 12/03/2024
Date Signed: 12/03/2024 02:36:23 PM

Document Has Been Signed on 12/03/2024 02:36 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:PROJECT INDEPENDENCEFACILITY NUMBER:
197606814
ADMINISTRATOR/
DIRECTOR:
ERIC WALKERFACILITY TYPE:
775
ADDRESS:43439 COPELAND CIRCLETELEPHONE:
(661) 948-8402
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 102CENSUS: 95DATE:
12/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Eric WalkerTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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At 09:00 am, Licensing Program Analyst (LPA) Lorena Casillas arrived at facility and met with Administrator Eric Walker, for an unannounced annual visit. LPA informed Administrator of the purpose of the visit and an entrance interview was conducted.

At 10:30 am a tour of the physical plant was conducted with Administrator to include staff areas and surroundings, the following was observed:

Infection control: LPA reviewed facility mitigation plan approved on 04/22/2021, to make sure licensee was following current infection control recommendations.

Common Areas: Designated areas for client use include, a home economics room, a hygiene room, an arts & crafts room, and exercise room, a computer room, and a large multi-purpose room. All rooms were neat and clean, clear of clutter and well lit.

Bathrooms: There are 2 bathrooms designated for clients, one for males, one for females. The restrooms were properly supplied, clean and had functional fixtures. The hot water temperature measured within regulation between 105 degrees F to 120 degrees F.

Kitchen: The facility does not provide meals, clients must bring their own or purchase from the cafeteria at Desert Haven next door. There is a staff kitchen that is equipped with a microwave and a refrigerator. The kitchen was clean with functional equipment. All areas designated for clients appeared well maintained and properly equipped.

Continued on LIC809-C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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: PROJECT INDEPENDENCE
FACILITY NUMBER: 197606814
VISIT DATE: 12/03/2024
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Surrounding Grounds: An outside covered patio area equipped with ceiling fans had appropriate seating for outdoor use for the clients. Transport vehicle(s) are located in the parking compound and appeared well maintained and in safe operating conditions.

Smoke Alarms and carbon monoxide detectors: The facility uses Hiller Lancaster fire company to service the alarm systems and was last inspected on 10/25/24. A fire/emergency drill is conducted every month and last took place on 10/21/24.

Staff and Client Files: At 11:30 am a review of Staff and Client Files was conducted. All files reviewed were complete and current.

Medications: The facility does not distribute medication, nor do they hold any medication.

Staff and Client Interviews: At 01:30 pm LPA interviewed ten (10) clients and five (5) staff members.

No citations issued. Exit Interview conducted, copy of report provided.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC809 (FAS) - (06/04)
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