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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609294
Report Date: 08/27/2024
Date Signed: 08/27/2024 01:16:32 PM

Document Has Been Signed on 08/27/2024 01:16 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:DIVINE FUTURES IIFACILITY NUMBER:
197609294
ADMINISTRATOR/
DIRECTOR:		PRISCILLA ISORDIAFACILITY TYPE:
735
ADDRESS:3631 E AVENUE H-10TELEPHONE:
(818) 270-6434
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: 4DATE:
08/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Priscilla IsordiaTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Lorena Casillas met with Administrator Priscilla Isordia for an unannounced one (1) year Required visit for this facility. LPA arrived at 10:00 am and was greeted and granted access by staff. Staff called Administrator, Priscilla Isordia and LPA explained the reason for the visit. The Administrator arrived shortly after. Entrance Interview conducted.

One (1) client observed in the living room, two (2) clients in their bedrooms, and the other client was at day program.

A tour of the physical plant was conducted with Administrator at 11:40 am. The facility has four (4) bedrooms and two (2) bathrooms currently occupying four (4) clients. The facility is Fire Cleared for four (4) ambulatory clients. There is awake staff at night.

Infection control: LPA reviewed facility infection control plan (approved on 08/18/22) to make sure licensee was following current infection control recommendations.

Kitchen: LPA conducted a tour of the kitchen at approximately 11:40 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 clear of clutter. LPA observed all knives, sharp object, and medications locked and inaccessible to clients in care. There is one (1) fire extinguisher located in the kitchen. The Fire extinguisher was observed to be fully charged and last serviced 06/18/24.

Continued on LIC809-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/27/2024
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: DIVINE FUTURES II
FACILITY NUMBER: 197609294
VISIT DATE: 08/27/2024
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Common Areas: LPA observed the living room to be neat and clean along with the dining room. The facility maintains a comfortable temperature at 73°F. The smoke detectors and dual carbon monoxide detectors were tested and observed to be operational at 12:00 pm.

Bedrooms: 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 appropriate wash your hands signs posted. Hot water was tested at 11:50 am and measured within regulation at 119.2 degrees F.

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

Outside Area: LPA toured the outside area of the facility at 12:00 pm. LPA observed appropriate outdoor furniture with an umbrella for shade. No bodies of water on the premises.

Garage: LPA observed the garage to be attached to the facility and currently being used for extra general storage and storage for emergency food and water. The garage is attached to the laundry room and remains locked at all times.

Medications: At 12:10 pm LPA and Administrator reviewed medication and medication records.

Staff Files: LPA conducted a file review of staff records at 12:20 pm.

Resident Files: LPA conducted a file review of resident records at 12:30 pm.

Client and Staff Interviews: LPA conducted interviews at 1:00 pm.

Administrative: LPA collected LIC500, Resident Roster and Bond. Annual fees are not current. LPA provided PIN and Licensee paid immediately, providing LPA with confirmation.

No citations issued. Exit interview was conducted. Copy of this report was given to the Administrator.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024
LIC809 (FAS) - (06/04)
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