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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608598
Report Date: 01/07/2025
Date Signed: 01/07/2025 03:12:11 PM

Document Has Been Signed on 01/07/2025 03:12 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:MOLOCK RESIDENTIAL INC.FACILITY NUMBER:
197608598
ADMINISTRATOR/
DIRECTOR:
MONICA VARTANIANFACILITY TYPE:
735
ADDRESS:44333 STADIUM COURTTELEPHONE:
(661) 674-8592
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: 4DATE:
01/07/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Monica VartanianTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 01/07/2024 at 10:35 am, Licensing Program Analyst (LPA) Lorena Casillas conducted an unannounced one (1) year required visit for this facility. LPA informed the Administrator the purpose of the visit.

Infection control: LPA reviewed facility mitigation plan (approved on 01/30/21) to make sure the facility was following current infection control recommendations.

A tour of the physical plant was conducted with the Administrator at 11:15 am. The facility has five (5) bedrooms, with one (1) room designated for live in staff, and two (2) bathrooms currently occupying four (4) clients. All clients were out in the community.

Food Inspection: LPA conducted a tour of the kitchen around 11:20 am and observed there to be sufficient stock of two-day perishable and seven-day non-perishable foods. Frozen foods are properly wrapped and stored. Food storage and preparation areas are clean and inaccessible to pests. LPA observed all knives and sharp objects being double locked and inaccessible to clients in care. LPA observed medications to be locked and inaccessible to clients.

Resident Rooms: LPA observed all rooms to have the appropriate bedding. There is a night stand, chair, bedding and sufficient lighting for each bedroom.

Bathrooms: At 11:30 am LPA observed all bathrooms to have non-skid matts, grab bars, paper towels and wash your hands signs. Hot water was tested and measured within regulation at 117.7°F.

Laundry: LPA observed chemicals/hazardous items locked in the hallway closet, and under the kitchen sink. The laundry room was neat and clean.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: MOLOCK RESIDENTIAL INC.
FACILITY NUMBER: 197608598
VISIT DATE: 01/07/2025
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Living and dining: LPA observed the living room to be neat and clean along with the dining room. The facility maintains a comfortable temperature at 72°F. The smoke detectors and carbon monoxide detectors were tested and observed to be operational at 11:40 am. There is one (1) fire extinguisher, located in the kitchen. Fire extinguisher was observed to be full and last serviced in 01/12/2024, per Administrator, Fletchers Fire Protection Services will be in the home this month to service the extinguisher. Staff and resident files were observed to be locked and inaccessible to clients.

Physical environment: LPA toured the outside area of the facility at 11:50 am. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. There is no body of water on the premises.

Garage: LPA observed the garage to be attached to the facility. Extra food is stored in the deep freezer and the second refrigerator.

Administrative: LPA collected LIC500, Client Roster, Administrator Certificate and Bond Certificate. Annual fees are current.

Staff and Client Interviews: All clients were out in the community. There was no staff present during the visit.



Resident Files: LPA conducted a file review of resident records to ensure compliance of licensing forms at 1:30 pm.

Staff Files: LPA conducted a file review of staff records at 2:30 pm.

Medications: At 3:00 pm LPA and Administrator reviewed medication and medication records for proper documentation.

An exit interview was conducted, and a copy of this report was given to the Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
LIC809 (FAS) - (06/04)
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