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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609337
Report Date: 08/26/2024
Date Signed: 08/26/2024 12:11:21 PM

Document Has Been Signed on 08/26/2024 12:11 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:MOLOCK RESIDENTIAL IIFACILITY NUMBER:
197609337
ADMINISTRATOR/
DIRECTOR:		MONICA VARTANIANFACILITY TYPE:
735
ADDRESS:43140 E 33RD STREETTELEPHONE:
(661) 674-8592
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: 4DATE:
08/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Monica VartanianTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Lorena Casillas met with Administrator Monica Vartanian for an unannounced one (1) year Required visit for this facility. The facility is currently on a non-compliance plan.

LPA arrived at 09:30 am. There was no one in the facility. LPA Casillas called Administrator and was told that staff would meet with LPA in about 20 minutes. LPA was met by staff member. Administrator arrived shortly after. LPA informed the Administrator of the purpose of the visit. All clients were in their day programs or out in the community. Entrance interview conducted.

A tour of the physical plant was conducted with the Administrator at 10:45 am. The facility has five (5) bedrooms and two (2) bathrooms. It is currently occupied by four (4) clients. One (1) bedroom is designated for staff use only.

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

Kitchen: LPA conducted tour of the kitchen around 10:50 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 chemicals, all knives, and sharp objects in the locked kitchen cabinet under the sink. LPA observed the medications cabinet locked, along with the first aid kits. There is one (1) fire extinguisher located in the kitchen. The Fire extinguisher was observed to be full and last serviced on 01/12/2024.

Continued on LIC809-C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
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 II
FACILITY NUMBER: 197609337
VISIT DATE: 08/26/2024
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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 70°F. LPA observed staff and client files locked in the filing cabinet. The smoke detectors and carbon monoxide detector were tested and observed to be operational at 10:55 am.
Laundry: LPA observed the laundry room, and no chemicals or hazardous materials are stored there.

Bedrooms: LPA observed rooms to have the appropriate bedding. There is a nightstand and sufficient lighting for each client. LPA observed cleaning supplies/chemicals in the locked hallway closet. The staff bedroom was locked and inaccessible to clients. Administrator unlocked staff bedroom and LPA observed more cleaning solutions being stored in staff room.

Bathrooms: LPA observed all bathrooms to have non-skid mats, grab bars, and the appropriated wash your hands signs posted. Hot water was tested at 11:00 am and measured within regulation at 112.4 degrees F.

Garage: At 11:05 am, LPA observed the garage to be attached to the facility and currently being used extra storage with an additional refrigerator and small deep freezer.

Outside Area: LPA toured the outside area of the facility at 11:10 am. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. No bodies of water on the premises.

Administrative: LPA collected LIC500, bond, administrator certificate and client roster. Annual fees are current.

Resident Files: LPA conducted a file review of client records at 11:15 am. Staff Files: LPA conducted a file review of staff at 11:45 am.



Client and Staff Interviews: There were no clients present during the visit. LPA interviewed Administrator.

Medications: At 12:00 pm LPA and Administrator reviewed medication and medication records.

No Citations Issued. Exit interview conducted. A copy of this report was provided to the Administrator.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC809 (FAS) - (06/04)
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