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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608043
Report Date: 12/01/2023
Date Signed: 12/01/2023 03:40:16 PM

Document Has Been Signed on 12/01/2023 03:40 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:BOOTS BETTER LIVINGFACILITY NUMBER:
197608043
ADMINISTRATOR:WILLIE JORDANFACILITY TYPE:
735
ADDRESS:3021 KILDARE STREETTELEPHONE:
(661) 951-9548
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 6CENSUS: 6DATE:
12/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Willie JordanTIME COMPLETED:
04:00 PM
NARRATIVE
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On 12/01/2023 at 1:50 p.m. Licensing Program Analyst (LPA) Evelin Rios arrived at the facility listed above to conduct an unannounced required annual inspection. LPA was greeted by administrator Willie Jordan. LPA explained the reason for the visit. Entrance Interview conducted.
The facility has three (3) client bedrooms that are shared and (3) bathrooms. The facility is Fire Cleared for six (6) ambulatory clients.

A tour of the physical plant was conducted with the administrator at approximately 2:00 p.m. and the following was observed:

Kitchen: LPA conducted a tour of the kitchen and observed there to be sufficient supply of two-day perishables and seven-day non-perishables foods, properly stored. Food storage and preparation areas are clean and clear of clutter. LPAs observed all sharp objects, locked in a kitchen cabinet inaccessible to clients in care. LPA observed a fire extinguisher located in the kitchen fully charged.

Living and dining areas: LPA observed the living area and dining area to be clean and clear of clutter. The furniture was in good repair and sits the capacity of the facility. At 2:10 p.m. LPA observed Administrator test a smoke detector. Detectors are dual Carbon Monoxide and are interconnected to other detectors located through out the facility. LPA observed smoke/carbon monoxide detectors functioning properly.

Bedrooms: LPA inspected three (3) out of three (3) client bedrooms. Bedrooms are shared. LPA observed each client room to be properly furnished with two beds, bedding and with sufficient lighting and storage. LPA also observed a fourth bedroom used by clients as a game room. (Continued on LIC809-C)
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2023
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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: BOOTS BETTER LIVING
FACILITY NUMBER: 197608043
VISIT DATE: 12/01/2023
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(Continued from LIC809)
Bathrooms: The facility has 3 bathrooms. LPA took water temperature from one (1) out three (3) bathrooms and temperature was 114.8 degrees F. LPA observed the bathrooms to be clean and properly supplied with hand soap, toilet paper and paper towels.

Laundry: Laundry area is located upstairs by the clients bedrooms. Detergents are kept locked in a cabinet by the laundry appliances.

Surrounding Grounds: Entry and exits were free of obstructions. There is appropriate outdoor furniture for clients to use. The attached garage has a deep freezer, emergency food, and extra facility furniture.

Client/Staff Records: At approximately 2:20 p.m. six (6) out six (6) client records and (2) staff records were reviewed to insure compliance with licensing forms. Records are kept locked and secured.

Medications: Centrally stored medications are maintained locked in a kitchen cabinet. Medications were observed locked. Multiple pharmacies are being utilized for client use. Refills are either done automatically or ordered by the physician. Medication Records were reviewed for proper documentation. Medication records are maintained manually.


Pursuant to Title 22 Division of the CA Code of Regulations, there were no deficiencies observed during todays visit. Exit Interview Conducted. A Copy of the Report Issued.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023
LIC809 (FAS) - (06/04)
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