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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609727
Report Date: 03/10/2022
Date Signed: 02/13/2023 11:26:01 AM

Document Has Been Signed on 02/13/2023 11:26 AM - 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:WE R ONE FAMILY HOME, INC.FACILITY NUMBER:
197609727
ADMINISTRATOR:TYRONE QUALSFACILITY TYPE:
735
ADDRESS:723 E. OLDFIELD STTELEPHONE:
(562) 644-7260
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: 0DATE:
03/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:AttemptedTIME COMPLETED:
09:45 AM
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Licensing Program Analyst (LPA) Shira Stamps arrived to the facility at 9:32 am and knocked on the door; there was no answer. LPA observed there were no cars in the driveway and the front porch light was on.

At 9:40 am, LPA called the Administrator, Tyrone Quals (562-644-7260)and LPA stated the purpose of the call. LPA asked the Administrator to meet LPA at the facility. The Administrator stated he was working until six (6) and unable to meet. LPA asked if the Designee would be able to come to the facility. The Administrator stated the designee was working and was unable to come to the facility. The Administrator stated they have no residents at the facility, and would like to set a time to do the annual inspection. LPA informed the Administrator all visits must be unannounced.

LPA was unable to obtain signature of the Administrator.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2022
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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