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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610218
Report Date: 12/07/2022
Date Signed: 12/07/2022 02:42:21 PM

Document Has Been Signed on 12/07/2022 02:42 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:ALBARIDA ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
197610218
ADMINISTRATOR:ALBARIDA, OSCARFACILITY TYPE:
735
ADDRESS:41853 YUMA COURTTELEPHONE:
(818) 572-5709
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY: 4CENSUS: 4DATE:
12/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Oscar AlbaridaTIME COMPLETED:
01:30 PM
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LPA Spaeth conducted an unannounced visit and was greeted by Administrator. LPA stated the purpose of the visit and LPA observed COVID signs within the facility along with the sign in station. LPA observed the Administrator was wearing a mask. LPA observed a resident within the facility and another resident arrived after participating in an adult day program.

LPA and Administrator began the tour at 12:35 pm until 1:05 pm. LPA observed the facility was nice and clean. The living room and dining room are combined. LPA observed comfortable seating and a dining room table and chairs. Upon entering the kitchen, LPA observed the kitchen was clean. Hand soap and paper towels were located at the sink. There were no cleaning products located underneath the kitchen sink and the cabinet was locked. The knives were locked in a kitchen cabinet. There is a two-day supply of perishable food in the refrigerator and a seven-day supply of canned goods and pasta in the pantry.

LPA observed the family room which contained comfortable seating and a television. The laundry room was locked and LPA observed the washer/dryer, laundry detergent, bleach and cleaning products safely locked in the room. The downstairs bathroom contained hand soap, paper towels, and trash can.

LPA observed the three resident rooms which were neat and clean. All rooms contained a bed, linens, chest of drawers, night stand, lamp and closet. The two upstairs bathrooms contained hand soap, paper towels, and trash cans. LPA observed a locked cabinet on the second floor which contained all the resident hygiene items. LPA also observed a 90 day supply of PPE .LPA observed the backyard contains comfortable seating and the gate to the pool was locked. The side gate that leads from the backyard to the front yard was not locked.

There are no deficiencies to report. Exit interview was conducted, and a copy of the signed report was given to the Administrator.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2022
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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