<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608902
Report Date: 12/15/2021
Date Signed: 12/15/2021 06:11:57 PM

Document Has Been Signed on 12/15/2021 06:11 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:PARTNERS FOR POTENTIAL,INC.FACILITY NUMBER:
197608902
ADMINISTRATOR:LISA WILLIAMSENFACILITY TYPE:
775
ADDRESS:25022 HAWKBRYN AVENUETELEPHONE:
(661) 253-4545
CITY:NEWHALLSTATE: CAZIP CODE:
91321
CAPACITY: 56CENSUS: 81DATE:
12/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:02 PM
MET WITH:Danielle Martin, Program ManagerTIME COMPLETED:
04:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Abeye Duguma met with the Program Manager, Danielle Martin for a One (1) Year Required - Infection Control visit for this facility. LPA explained the reason for the visit. A tour of the physical plant was conducted at 2:00pm and the following was noted:
There is one entrance being utilized at the facility, there are required posters posted at the main door. Screening area is located immediately upon entrance. Sign-in sheet, infrared thermometer, hand sanitizer, gloves and masks are available. LPA was screened upon entry. All staff were observed to be wearing masks upon entrance and during the visit. Signs to wear masks and other COVID 19 prevention protocol signs were posted outside the doors. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has an outdoor shaded area for clients, located on the northeast side of the building. The facility has sufficient stock of PPE in an office room located near the front entrance. The facility has a total of four (04) restrooms of which two (02) are for staff. The facility does not have a swimming pool/body of water. Kitchenette area is clean and inaccessible to pests. The facility does not keep knives and sharps. Common/activity room furniture were checked and appear to be in good condition. The common/activity rooms are neat and clean. The facility maintains a comfortable temperature at 70°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. The facility has fire sprinkler system. Fire extinguishers are located throughout the building, observed to be full and last inspected on 10/12/2021. Hallways/passageways are well lit. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 119.2°F. There is a complete first aid kit located in the office area.

Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2021
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 1