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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609727
Report Date: 06/06/2023
Date Signed: 06/06/2023 02:52:37 PM

Document Has Been Signed on 06/06/2023 02:52 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
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:
06/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Tyrone Quals, Licensee TIME COMPLETED:
03:05 PM
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Licensing Program Analyst (LPA) Shira Stamps arrived at 11:15 am and the Licensee Tyrone Quals was contacted at 11:20 am for an annual required inspection. The Licensee stated he was in Los Angeles and could be at the facility in two (2) hours. The Licensee arrived at 1:00 pm.
Entrance interview conducted.

LPA and the Licensee conducted a tour of the facility at 1:20 pm. The Licensee stated he has no clients and is still getting vendorized by the North Los Angeles Regional Center. LPA observed the license, Complaint Poster and Bill of Rights posted throughout the facility.

Common Areas: LPA toured all common areas of the facility. LPA observed common areas to be clean and furniture to be in good repair. The facility maintains a comfortable temperature at 77 degrees F. LPA observed the fire extinguisher to be full and last serviced on 4/06/23.

Client rooms: LPA observed client’s rooms to have appropriate bedding sheets, pillowcase, mattress pad, and blankets, which are in good condition. There is at least one chair, night stand and sufficient lighting for each client.

Bathrooms: At 1:36 pm LPA observed the bathrooms to have a non-skid matts and appropriate grab bars in each bathroom. Clients will have sufficient amounts of supplies for personal hygiene which is provided by the Licensee. The hot water first measured at 125 degrees F, but the Licensee adjusted the temperature, and will send verification to the LPA once it measures between 105 F and 120 F.

Laundry service: There is enough linen available to change weekly or more if need.

Outside areas: LPA observed a covered shaded area for clients, and the outdoor furniture currently being stored in the garage until the facility has clients. There are no bodies of water on the premises.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2023
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: 06/06/2023
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Food Inspection: LPA conducted a food inspection tour at 1:30 pm. LPA observed there to be sufficient stock of seven-day non-perishables foods. Snacks and beverages are available for future clients. Food storage and preparation areas are clean and inaccessible to pests. At 1:30 pm LPA observed the carbon monoxide detector and smoke detectors to be working.

Exit interview conducted. Copy of report delivered to Licensee.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
LIC809 (FAS) - (06/04)
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