197607859-12-11-2024-31-AS-LCAS-DBUTKR-20241211134821

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607859
Report Date: 12/11/2024
Date Signed: 12/11/2024 01:49:10 PM

Document Has Been Signed on 12/11/2024 01:49 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:	DIANA'S MARIAN RES. CARE FACILITY 1 LLC		FACILITY NUMBER:	197607859
ADMINISTRATOR/ DIRECTOR:	DIANA SORIANO		FACILITY TYPE:	740
ADDRESS:	44047 RODIN AVENUE		TELEPHONE:	(661) 726-7674
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 4	DATE:	12/11/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Diana Soriano		TIME VISIT/ INSPECTION COMPLETED:	02:05 PM

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Licensing Program Analyst (LPA) Lorena Casillas arrived at the facility at 09:15 am. LPA was greeted by staff who called Administrator Diana Soriano to advise that LPA was present. Administrator arrived shortly after.

A tour of the physical plant was conducted with the Administrator at 09:45 am. The facility has four (4) bedrooms and two (2) bathrooms. It is currently occupied by four (4) clients. One (1) bedroom and one (1) bathroom are designated for staff use only.

Infection control: LPA reviewed facility infection control plan (approved on 06/08/2022) to make sure licensee was following current infection control recommendations.

Kitchen: LPA conducted a tour of the kitchen at 10:00 am and observed there to be sufficient stock of two-day perishable and seven-day non-perishable foods. Frozen foods are properly wrapped and stored. Food storage and preparation areas are clean and inaccessible to pests. Medication and knives are stored in locked cabinets. First aid kit furnished and fully equipped.

Common Areas: LPA observed the living room to be neat and clean along with the dining room. The facility maintains a comfortable temperature at 71°F. LPA observed staff and client files locked in the filing cabinet in the office. The smoke detectors and carbon monoxide detectors were tested and observed to be operational at 10:10 am. There are three (3) fire extinguishers located in the kitchen, hallway, and garage. The fire extinguishers were observed to be full and last serviced on 04/03/2024.

Continued on LIC809-C

Nichelle Gillyard	TELEPHONE: (818) 596-4370
Lorena Casillas	TELEPHONE: 818-304-2695
	DATE: 12/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024

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: DIANA'S MARIAN RES. CARE FACILITY 1 LLC	FACILITY NUMBER: 197607859
	VISIT DATE: 12/11/2024

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Bedrooms: LPA observed rooms to have the appropriate bedding. There is a nightstand and sufficient lighting for each client. LPA observed sufficient linens and towels in the hallway closet. All windows had adequate screens and egress was functioning in all the rooms.

Bathrooms: LPA observed bathroom to have the appropriated wash your hands signs posted. The bathroom was clean, with soap and paper towels for clients. Hot water was tested in the client bathroom and measured 119.4 degrees Fahrenheit.

Surrounding Grounds: There were no visible hazards, and passageways were free from obstruction. The gate was unlocked and easily accessible. There is a covered patio. Garage entrance was locked and secure. Garage contains PPE equipment, laundry area and a freezer that has plenty of frozen food that was wrapped and stored appropriately. There is a storage area with additional canned items along with emergency food. Chemicals and household supplies were locked and stored in a locked cabinet in the garage.

Administrative: LPA collected LIC500, Liability insurance, Administrator certificate and resident roster. Annual fees are not current. LPA provided PIN to Administrator and the fees were paid during the visit.

Staff and Resident Interviews: LPA interviewed residents at 11:00 am. LPA interviewed staff at 11:30 am.

Staff Files: LPA conducted a file review of resident records at 12:05 pm.

Resident Files: LPA conducted a file review of staff records at 12:30 pm.

Medications: At 01:05 pm LPA and staff reviewed medication and medication records for proper documentation.

No deficiencies were observed, an exit interview was conducted, and a copy of this report was given to the Administrator.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena Casillas	TELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024

LIC809 (FAS) - (06/04)

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