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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609727
Report Date: 06/28/2021
Date Signed: 06/28/2021 10:26:54 AM

Document Has Been Signed on 06/28/2021 10:26 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:
06/28/2021
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Mike LeeTIME COMPLETED:
10:00 AM
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LPA Spaeth conducted an annual continuation visit. Since the facility does not have any residents, LPA Spaeth previously came to the facility on May 26, 2021 to conduct the annual inspection. However, there were no residents or staff members present since the facility does not have any residents at this time. LPA Spaeth spoke to Administrator, Tyrone Quals by telephone and arranged a time for LPA to complete a tour of the facility. LPA Spaeth arrived at 9:02 am and was greeted by Mike Lee, House Manager. LPA observed the COVID 19 signs on the front door. Upon arrival and entering, LPA Spaeth observed the sign in station, LPA's temperature was taken, COVID symptom questions were completed, and LPA signed in. LPA observed hand sanitizer located on the sign in table. Upon entering LPA observed the living room fully furnished.

Upon entering the kitchen, LPA observed the kitchen, dining room and family room are combined together. The family room contained comfortable seating and the kitchen table was set up. Upon entering the kitchen, LPA observed wash your hands sign, hand soap, and paper towels. LPA observed a locked cabinet where cleaning supplies and knives were locked. LPA observed a locked cabinet designated for the residents' medications.

LPA viewed all four bedrooms which were furnished and two bathrooms. The bathrooms contained wash your hands sign, hand soap, paper towels, and trash can. LPA Spaeth observed a linen storage area in the hallway which contained an ample supply of linens and bath towels. LPA observed a 90 day supply of needed PPE. LPA observed the garage is the location for the wash and dryer. LPA Spaeth observed the the backyard. House Manager explained the outdoor furniture is locked in the garage and will be placed in the backyard once the facility admits residents.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2021
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: 06/28/2021
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LPA Spaeth observed dishes that were washed and were drying in the kitchen. LPA Spaeth spoke to Administrator by phone at 9:42 am asking if a staff member or other person was living in the facility. Administrator stated there are no residents or staff members livingin the facility at this time. Administrator stated however, since the property is empty, the facility has been vandalized on two occasions. Administrator stated that the facility is checked to make sure there is no property damage. House Manager the dishes that are in the kitchen have been on the drying rack for some time and stated the Administrator stayed on the premises with the property damage occurred.

There are no deficiencies to report during this visit. Exit interview was conducted and a copy of the report will be sent to Administrator.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2021
LIC809 (FAS) - (06/04)
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