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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608245
Report Date: 12/08/2022
Date Signed: 12/08/2022 01:12:04 PM

Document Has Been Signed on 12/08/2022 01:12 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:LOUISE HOUSE 2FACILITY NUMBER:
197608245
ADMINISTRATOR:JULIANN BARBERFACILITY TYPE:
735
ADDRESS:6455 TUSCAN COURTTELEPHONE:
(661) 526-3983
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY: 6CENSUS: 6DATE:
12/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Juliann Barber, AdministratorTIME COMPLETED:
01:30 PM
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At 12:00pm, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA observed COVID-19 signage posted outside on the front door and along the main entrance. LPA met with Staff #1 who granted access to the facility. Administrator arrived shortly after and LPA explained the reason for the visit.

At 12:15pm LPA conducted a tour of the physical plant and observed the following:

Facility is an Adult Residential Facility which is licensed for six (6) ambulatory clients. Facility has four bedrooms, two bathrooms designated for clients use. The facility has one awake staff member at all time. LPA was able to tour the home and did not observe any immediate health and safety concerns. Sufficient PPE supplies were observed. Smoke detectors and carbon monoxide monitors were observed to be functional. Facility maintains a temperature of 72°F. LPA observed there to be sufficient stock of one-week non-perishable foods and two-day perishable foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Sharps, cleaning supplies and medications are centrally stored and are kept locked in kitchen cabinet and drawer. LPA observed a fire extinguisher located in the kitchen and it was last serviced on 03/15/2022. Bedrooms are appropriately furnished and have appropriate lighting. Bathrooms have soap, paper towels and hand washing signs were observed. Extra towels and linens were readily available. Laundry area is located by the garage and all detergents were observed to be locked and inaccessible to clients. LPA observed a clean covered patio and discussed the importance of maintaining the care and supervision to meet the needs of clients. There are no bodies of water.

No deficiencies issued during today’s visit. An exit interview was conducted and copy of this report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2022
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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