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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609727
Report Date: 03/11/2022
Date Signed: 03/11/2022 11:27:05 AM

Document Has Been Signed on 03/11/2022 11:27 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:
03/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:32 AM
MET WITH:Tyrone Quals, AdministratorTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Shira Stamps met with the Licensee, Tyrone Quals for an unannounced one (1) year Required visit for this facility. LPA arrived at 10:32 am and was greeted by the Licensee. LPA informed the Licensee of the purpose of the visit.

Infection control: LPA reviewed the facility mitigation plan (approved on 04/22/21) to make sure the licensee was following current infection control recommendations. Upon arrival LPA was screened by the Licensee.

A tour of the physical plant was conducted with the Licensee at 10:37 am. The facility has four (4) bedrooms and two (2) bathrooms currently occupying no clients at this time.

Food Inspection
LPA conducted a tour of the kitchen around 10:40 am and observed a startup supply of non-perishable foods. Food storage and preparation areas care clean and inaccessible to pests. LPA observed all knives and sharp objects locked in the cabinet under the sink with chemicals and cleaning supplies. LPA observed where the medications will be located in a locked cabinet inaccessible to clients in care.

Laundry/Garage
At 10:42 am, LPA observed the laundry room located in the garage. The Garage is attached to the facility and currently being used for extra storage.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2022
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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: WE R ONE FAMILY HOME, INC.
FACILITY NUMBER: 197609727
VISIT DATE: 03/11/2022
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Living and dining
At 10:45 am, LPA observed the living room to be neat and clean along with the dining room. The facility maintains a comfortable temperature at 66°F. The smoke detectors and carbon monoxide detectors were tested and observed to be operational at 10:48 am. There is one (1) fire extinguisher located in the kitchen. The fire extinguisher was observed to be full and last serviced on 03/11/22. LPA observed where staff and client files will be locked in the filing cabinet.

Resident Rooms
At 10:47 am, LPA observed rooms to have the appropriate bedding. There is a nightstand and sufficient lighting for each resident. LPA observed extra sheets and towels located in the hallway cabinet.

Physical environment
LPA toured the outside area of the facility at 10:46 am. LPA observed appropriate outdoor furniture stored in the garage until clients are present. LPA observed a covered shaded area for clients. No bodies of water on the premises.

Bathrooms
At 10:50 am LPA observed all bathrooms to have non-skid matts and the appropriated wash your hands signs posted in the bathroom. Hot water was tested and measured within regulation at 116.8 degrees F

Administrative: Annual fee is current.

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

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

DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022
LIC809 (FAS) - (06/04)
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