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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609727
Report Date: 05/28/2024
Date Signed: 05/28/2024 02:50:15 PM

Document Has Been Signed on 05/28/2024 02:50 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:WE R ONE FAMILY HOME, INC.FACILITY NUMBER:
197609727
ADMINISTRATOR/
DIRECTOR:		TYRONE QUALSFACILITY TYPE:
735
ADDRESS:723 E. OLDFIELD STTELEPHONE:
(562) 644-7260
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: 4DATE:
05/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Vashan BobneyTIME VISIT/
INSPECTION COMPLETED:
03:05 PM
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Licensing Program Analyst (LPA) Lorena Casillas arrived at 10:00 am to the facility and the Administrator Tyrone Quals was contacted for an annual required inspection. Administrator would not be able to meet with LPA and assigned House Manager (HM) Vashan Bobney to sign the report. Entrance interview conducted.

Upon arrival LPA was asked to sign visitor log. LPA and the HM conducted a tour of the facility at 12:45 pm. The facility has four (4) bedrooms and two (2) bathrooms currently occupying four (4) clients at this time.

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

Living and Dining: 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 74 degrees F. LPA observed the fire extinguisher to be full and last serviced on 04/05/2024.

Kitchen: LPA conducted a food inspection tour at 12:45 pm. LPA observed there to be sufficient stock of two days perishable foods and seven-days non-perishables foods. Snacks and beverages are available for clients. Food storage and preparation areas are clean and inaccessible to pests. Weekly grocery shopping is routinely done on Mondays. At 12:55 pm LPA observed the carbon monoxide detector and smoke detectors to be working.

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

Continued on LIC809-C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/28/2024
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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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: WE R ONE FAMILY HOME, INC.
FACILITY NUMBER: 197609727
VISIT DATE: 05/28/2024
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Bathrooms: At 1:00 pm LPA observed the bathrooms to have a non-skid matts and appropriate grab bars in each bathroom. The hot water first measured at 110.8 degrees F.

Garage: Garage is secured and holds laundry equipment. It is also used for extra storage. Laundry detergent is kept locked and inaccessible to residents in a locked hallway closet.

Outside areas: LPA observed a covered shaded area for clients and outdoor furniture in good condition. There are no bodies of water on the premises.

Administrative: LIC 500 and client roster collected. Annual fee is current.

Client Files: LPA conducted a file review of resident records to ensure compliance of licensing forms at 1:10 pm.



Staff Files: LPA conducted a file review of staff records to ensure forms and training are up to date and compliance with licensing forms at 1:45 pm.

Medications: At 2:00 pm LPA and HM reviewed medication and medication records for proper documentation.

Staff Interviews: At 2:15 pm LPA interviewed staff.

Client Interviews: At 2:30pm LPA interviewed clients.

There are no deficiencies to report and no citations to be issued. Exit interview was conducted and a copy of the report was given to the HM.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2024
LIC809 (FAS) - (06/04)
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