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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609294
Report Date: 08/05/2022
Date Signed: 08/05/2022 02:44:20 PM

Document Has Been Signed on 08/05/2022 02:44 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:DIVINE FUTURES IIFACILITY NUMBER:
197609294
ADMINISTRATOR:PRISCILLA ISORDIAFACILITY TYPE:
735
ADDRESS:3631 E AVENUE H-10TELEPHONE:
(818) 270-6434
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: 4DATE:
08/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Priscilla Isordia, Administrator TIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Shira Stamps met with Administrator Priscilla Isordia for an unannounced one (1) year Required visit for this facility.

LPA arrived at 1:30 pm and was greeted by caregiver Geraldine Moreno. One (1) client observed in the living room watching TV, one (1) client doing a coloring activity, and the other clients were in their room or at day program. The Administrator arrived at 2:00pm. LPA informed the Administrator of the purpose of the visit. Entrance Interview conducted.

Infection control: LPA reviewed facility mitigation plan (approved on 03/13/21) to make sure licensee was following current infection control recommendations. Upon arrival LPA was screened by the caregiver and asked all infection control questions. LPA signed in and sanitizer was available.

A tour of the physical plant was conducted with Administrator at 2:05pm. The facility has four (4) bedrooms and two (2) bathrooms currently occupying four (4) clients. The facility is Fire Cleared for four (4) ambulatory.

Food Inspection
LPA conducted a tour of the kitchen at approximately 2:05 pm and observed there to be sufficient stock of two-day perishables and seven-day non-perishables foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas care clean and inaccessible to pests. LPA observed all knives, sharp object, and medications locked and inaccessible to client in care.

CONTINUED...
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: DIVINE FUTURES II
FACILITY NUMBER: 197609294
VISIT DATE: 08/05/2022
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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 70°F. The smoke detectors and dual carbon monoxide detectors were tested and observed to be operational at 2:20pm. There is one (1) fire extinguisher located in the kitchen. The Fire extinguisher was observed to be full and last serviced on 04/12/22.

Resident Rooms
LPA observed rooms to have the appropriate bedding. There is a nightstand and sufficient lighting for each client.

Bathrooms
LPA observed all bathrooms to have the appropriated wash your hands signs posted. Hot water was tested at 2:12 pm and measured within regulation at 120.0 degrees F.

Laundry
LPA observed the laundry room to be locked and inaccessible to clients in care.

Physical environment
LPA toured the outside area of the facility at 12:20pm. LPA observed appropriate outdoor furniture, with a covered shaded area for clients stored in the garage due to windy weather. No bodies of water on the premises.

Garage
LPA observed the garage to be attached to the facility and currently being used for storage and PPE supplies. The garage is attached to the laundry room and remains locked at all times.

Administrative: LPA collected the LIC.500 and client roster.

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

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2022
LIC809 (FAS) - (06/04)
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