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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609335
Report Date: 11/18/2024
Date Signed: 11/18/2024 01:47:42 PM

Document Has Been Signed on 11/18/2024 01:47 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:PEOPLE'S CARE MCENNERY CANYONFACILITY NUMBER:
197609335
ADMINISTRATOR/
DIRECTOR:		SARAH LONGFACILITY TYPE:
735
ADDRESS:34310 MCENNERY CANYON RDTELEPHONE:
(661) 269-2679
CITY:ACTONSTATE: CAZIP CODE:
93510
CAPACITY: 4CENSUS: 4DATE:
11/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Sarah LongTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 11/18/2024 Licensing Program Analyst (LPA) Lorena Casillas met with administrator Sarah Long for an unannounced one (1) year Required visit for this facility.

LPA arrived at 10:00 am and was greeted by staff member. Three (3) clients were present, and one (1) client was attending program. Staff member contacted Administrator, and Administrator arrived shortly after. LPA informed Administrator of the purpose of the visit. Entrance interview conducted.

A tour of the physical plant was conducted with Administrator at 11:00 am. The facility has four (4) bedrooms and three (3) bathrooms currently occupying four (4) clients. The facility is Fire Cleared for four (4) ambulatory, two (2) of which may be non-ambulatory. Room #3 and #4 are for non-ambulatory clients.

Infection control: LPA reviewed facility mitigation plan (approved on 12/13/21) to make sure licensee was following current infection control recommendations.

Kitchen: LPA conducted tour at the kitchen around 11:20 am 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, medications, and chemicals being locked and inaccessible to clients in care.

Common Areas: LPA observed the living room to be neat and clean along with the dining room. The facility maintains a comfortable temperature at 69°F. The smoke detectors and carbon monoxide detectors were tested and observed to be operational at 11:30 am. There are two (2) fire extinguishers located in the kitchen and the laundry room. The fire extinguishers were observed to be full and last serviced on 02/06/2024. Staff and client files were observed to be locked and inaccessible to clients in care.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2024
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: PEOPLE'S CARE MCENNERY CANYON
FACILITY NUMBER: 197609335
VISIT DATE: 11/18/2024
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Laundry: At 11:40 am LPA observed detergents and chemicals to be locked in laundry room.

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

Bathrooms: At 11:50 am LPA observed all bathrooms to have non-skid matts and the appropriated wash your hands signs posted. Hot water was tested and measured within regulation at 114.4 degrees F.

Garage: LPA observed the garage to be attached to the facility and currently being used for extra food storage.

Physical environment: LPA toured the outside area of the facility at 12:00 pm. LPA observed appropriate outdoor furniture, with a shaded area for clients. No bodies of water on the premises.

Administrative: LPA collected the LIC500, Bond, Administrator Certificate and Client roster. Annual fee is current.

Client & Staff Files: LPA conducted a file review of client and staff records at 12:30 pm.



Medications: At 12:45 pm LPA and Administrator reviewed medication and medication records for proper documentation.

Staff and Client Interviews: At 1:00 pm LPA interviewed clients and staff in the home.

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

DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
LIC809 (FAS) - (06/04)
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