197610131-9-27-2022-31-AS-SSTS-CJNTUM-20220927150234

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610131
Report Date: 09/27/2022
Date Signed: 09/27/2022 03:02:43 PM

Document Has Been Signed on 09/27/2022 03:02 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:	REM CALIFORNIA LLC - DESERT HILLS		FACILITY NUMBER:	197610131
ADMINISTRATOR:	IBRAHIM, MOSHOOD		FACILITY TYPE:	735
ADDRESS:	8241 WEST AVENUE C-14		TELEPHONE:	(818) 415-4301
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93536
CAPACITY: 4		CENSUS: 3	DATE:	09/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Amparo Murvin, Administrator		TIME COMPLETED:	03:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Shira Stamps met with Administrator Amparo Murvin for an unannounced one (1) year Required visit for this facility. LPA arrived at 1:50 pm and was greeted by the Administrator. One (1) client was observed in the living room The other clients were away at their day programs. LPA informed the Licensee of the purpose of the visit. Infection control: LPA reviewed facility mitigation plan (approved on 04/28/21) to make sure licensee was following current infection control recommendations. Upon arrival LPA was screened by the Licensee and asked all infection control questions. LPA was asked to sign-in and sanitizer was available. A tour of the physical plant was conducted with Administrator at 2:07 pm. The facility has four(4) bedrooms and three (3) bathrooms currently occupying three (3) clients. One (1) bathroom is designated for staff use only and the facility has awake staff at night. Living and dining LPA observed the living room to be neat and clean along with the dining room and family room. The facility maintains a comfortable temperature at 74°F. The smoke detectors dual carbon monoxide detectors were tested and observed to be operational at 2:30 pm. There are two (2) fire extinguishers, one (1) is located in the family room and one (1) is located in the kitchen. The Fire extinguishers were observed to be full and last serviced on 12/15/21. Resident Rooms LPA observed rooms to have the appropriate bedding. There is a night stand and sufficient lighting for each resident. LPA tested the exit doors auditory system and it was observed to be operational for each room.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022

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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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: REM CALIFORNIA LLC - DESERT HILLS	FACILITY NUMBER: 197610131
	VISIT DATE: 09/27/2022

NARRATIVE

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Food Inspection
LPA conducted a tour of the kitchen around 2:18 pm and observed there to be sufficient stock of two-day perishables and seven-day non-perishables foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. LPA observed all knives and sharp object being double locked and inaccessible to clients in care. The Medication cabinet and closet was observed to be locked and inaccessible to clients in care

Bathrooms
At 2:11 pm LPA observed all bathrooms to have non-skid matts, grab bars, and the appropriated wash your hands signs posted. Hot water was tested and measured within regulation at 115.0 degrees F.

Laundry
LPA observed chemicals/hazardous items in the locked cabinet in the laundry room.

Physical environment
LPA toured the outside area of the facility at 2:28 pm. LPA observed appropriate outdoor furniture, with a covered shaded area for client. No bodies of water on the premises.

Garage
LPA observed the garage to be attached to the facility and currently being used for storage, an extra refrigerator and freezer, and PPE.

Administrative: LPA collected the LIC.500 and resident roster. Annual fee is current. LPA reminded the Administrator to maintain all resident and staff records.

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

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

LIC809 (FAS) - (06/04)

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