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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608471
Report Date: 05/16/2022
Date Signed: 05/16/2022 11:24:37 AM

Document Has Been Signed on 05/16/2022 11:24 AM - 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:BOOTS BETTER LIVING IIFACILITY NUMBER:
197608471
ADMINISTRATOR:STACI JORDANFACILITY TYPE:
735
ADDRESS:42444 BUTTERSCOTCH LANETELEPHONE:
(323) 394-9906
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 6CENSUS: 6DATE:
05/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Will JordanTIME COMPLETED:
11:40 PM
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At 10:30 a.m., Licensing Program Analyst (LPA) Melissa Ruiz arrived at the facility to conduct an infection control annual inspection. LPA was greeted by staff and LPAs temperature was taken, infection control questions were asked, and LPA was asked to sign the visitor’s log. LPA later met with Jordan Staci, Administrator. The purpose of the visit was explained, and an entrance interview was conducted.

Physical plant: At 10:40 a.m., LPA toured the facility. There are four (4) bedrooms, three (3) of which are designated for clients. LPA observed table and chairs to be in adequate repair. LPA observed there to be no obstructions of passageways. Wall and floors were adequate, clean, and in good repair. All trash cans were observed to have lids.

The kitchen area: LPA observed the kitchen area to be adequately clean. Sharps are kept locked and inaccessible to clients. The bathrooms: Trash cans in bathrooms have lids to protect clients from cross contamination. There is a designated laundry area where cleaning supplies are stored. These are kept locked and inaccessible to clients. PPE supplies were readily available for clients and staff. There is an attached garage.

Backyard: There is a designated shaded area with a table and chairs. No bodies of water.

No deficiencies were observed during today’s visit. An exit interview was conducted. A copy of this report was signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Melissa Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2022
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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