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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608043
Report Date: 09/24/2024
Date Signed: 09/24/2024 01:46:09 PM

Document Has Been Signed on 09/24/2024 01:46 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/
DIRECTOR:		WILLIE JORDANFACILITY TYPE:
735
ADDRESS:3021 KILDARE STREETTELEPHONE:
(661) 951-9548
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 6CENSUS: 6DATE:
09/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:13 AM
MET WITH:Willie JordanTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 09/24/2024 at 10:13 a.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. This is a two story home with 4 bedrooms and three bathrooms. The facility has an approved Fire Clearance for six (6) ambulatory clients.

A tour of the physical plant was conducted with the administrator at approximately 10:15 a.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. Knives and sharp objects are locked in the staff bedroom inaccessible to clients in care. LPA observed a fire extinguisher located in the kitchen fully charged. LPA observed the facility telephone accessible to clients on the kitchen counter.

Common Areas: These include the living area, dining area, and multi purpose room. LPA observed these areas to be clean and clear of clutter. The furniture was in good repair and sits the capacity of the facility. In the living area LPA observed an fire place closed with a screen.

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 staff room locked inaccessible to clients. At 10:21 a.m. LPA observed the administrator test the dual smoke and carbon monoxide detectors that are interconnected to other detectors located through out the facility. Detectors were observed to be functioning.
(Continued on LIC809-C)
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: 09/24/2024
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(Continued from LIC809)
Bathrooms: The facility has 3 bathrooms. LPA observed the bathrooms to be clean and properly supplied with hand soap, toilet paper and paper towels.

Laundry: Laundry room is located upstairs by the clients bedrooms. Laundry room was observed locked. Detergents are kept locked in the laundry room. LPA observed a washer and dryer that appear operational.

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 10:35 a.m. LPA reviewed the facility file and seven (7) out of seven (7) staff files. From 11:00 a.m. to 12:00 p.m. LPA reviewed six (6) out of six (6) client files. Records were reviewed to insure compliance with licensing forms.

Medications: Centrally stored medications are maintained locked in the staff room. Medications were observed locked. Centrally Stored Medication and Destruction Records were reviewed for proper documentation. Medication records are maintained manually. Facility also keeps manual medication administration records (MARs).

Pursuant to Title 22 Division 6 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: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
LIC809 (FAS) - (06/04)
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