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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608598
Report Date: 09/22/2022
Date Signed: 09/22/2022 11:45:35 AM

Document Has Been Signed on 09/22/2022 11:45 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:MOLOCK RESIDENTIAL INC.FACILITY NUMBER:
197608598
ADMINISTRATOR:MONICA VARTANIANFACILITY TYPE:
735
ADDRESS:44333 STADIUM COURTTELEPHONE:
(661) 674-8592
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: 4DATE:
09/22/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Monica Vartanian,AdministratorTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Shira Stamp arrived at the facility above at approximately 10:15am for a case management visit. The Administrator, Monica Vartarian, arrived around 10:45am. The purpose of this visit is to address the two (2) year compliance plan. Entrance interview conducted with the Administrator.

Today’s focus was infection control, heat related training for new staff, sufficient staffing for supervision, heat related preventative measures, and sufficient supply of food and water. LPA conducted a physical plant tour, conducted a record review, and interviewed staff that was present. All clients were currently in their day programs. LPA observed there to be sufficient stock of two- perishable and seven-day non-perishables foods. A sufficient supply of water was observed in the kitchen and in the garage. The HVAC/air conditioning system is working, and the facility maintains a comfortable temperature of 71 degrees F. The Administrator indicated that water is offered to clients every hour to thirty minutes, and when clients return to the facility. LPA observed two water bottles with time stamps for the two (2) non-verbal clients. The Administrator indicated the other two (2) verbal clients will keep water bottles in their rooms or access water in the kitchen. LPA reviewed the LIC 500 and found there to be sufficient staff for each shift. LPA reviewed the staff training files regarding heat related training and care and supervision, and LPA verified that all staff have completed this training. LPA collected training documents for the newest staff hire. The Administrator indicated that sunscreen is applied daily Monday thru Friday when clients go outside, and on the weekends it is applied if the clients go outside. LPA observed staff following current infection control requirements, such as wearing masks, screening visitors, asking infection control questions, and having COVID signs posted throughout the facility.

Exit interview conducted. Copy of report delivered to Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2022
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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