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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607726
Report Date: 01/27/2022
Date Signed: 01/27/2022 12:12:39 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:WILLIAM J. "PETE" KNIGHT VETERANS HOME-LANCASTERFACILITY NUMBER:
197607726
ADMINISTRATOR:ELVIE ANCHETAFACILITY TYPE:
740
ADDRESS:45221 30TH STREET WESTTELEPHONE:
(661) 974-7035
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:60CENSUS: DATE:
01/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Elvie AnchetaTIME COMPLETED:
12:20 PM
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At 10:20 a.m. Licensing Program Analysts (LPAs) Melissa Ruiz and Angela Panushkina conducted an unannounced annual inspection at this facility. LPAs were greeted by staff and later met with Administrator Elvie Ancheta, entrance interview was conducted. At 10:30 a.m. a physical tour was initiated with staff Seema Misra. Infection control: Upon arrival, staff took LPA’s temperature, was asked to sign-in the visitor’s log and was asked infection control questions. Proper signage was observed posted outside the facility and inside along the hallway. Hand sanitizer was also observed. LPA observed sufficient PPE supplies for residents and staff. Staff Seema stated there is a designated visitor’s entrance and a separate staff entrance, both of which consists of designated staff screening visitors and staff for infection control protocols. 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. Garbage cans have tight fitting covers in the kitchen. Sharps are kept inaccessible to residents. There are two designated snack rooms throughout the facility that are maintained open for residents 24/7. Medications are in a centrally stored and are kept locked in two nurse stations. Smoke detectors/carbon monoxide were located throughout the facility and was last inspected on 2/22/21, an official fire clearance report was obtained. Resident rooms: There are 36 bedrooms designated for resident use. All of which include private restrooms. All bedrooms are properly furnished, have appropriate bedding, and linens. Bathrooms: The hot water temperature measured at 115.8 F. Residents observed to have plenty of supplies for personal hygiene products. Outside areas: LPA toured the outside area of the facility. LPA observed appropriate outdoor seating, with various covered shaded areas for clients. There are no bodies of water. No deficiencies observed at this time. Exit interview conducted and report signed and delivered.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa RuizTELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022
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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