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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610218
Report Date: 12/01/2023
Date Signed: 12/01/2023 03:35:22 PM

Document Has Been Signed on 12/01/2023 03:35 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.ASC, 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:
12/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:OSCAR A. ALBARIDATIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced annual visit and was greeted by the Administrator, Oscar Albarida at 10:20 am. LPA Spaeth stated the purpose of the visit was to conduct the annual inspection. The facility is licensed for 4 ambulatory clients. Administrator confirmed three clients are attending an adult day program and one client was at the facility due to some health issues.

LPA and Administrator began the tour at 10:00 am until 10:30 am and observed the following:

Living Room/Dining Room Combination - LPA observed the living room and dining room are combined together. The living room section contained comfortable seating and the dining room contained a dining room table with chairs. LPA observed the residents’ medications were safely locked in the dining room closet. Additional PPE is also stored in a dining room cabinet.

Kitchen - The knives were locked in a cabinet. The dish soap, and cleaning supplies were locked underneath the kitchen sink. There is a seven-day supply of non-perishable food and a two day supply of perishable food items. LPA observed the first aid kit which contained tweezers, scissors and bandages were locked in a kitchen cabinet. At 10:25 am, LPA tested the water temperature which was observed to be 111.6 degrees F. LPA observed two fire extinguishers in the kitchen.

Family Room - LPA observed a large family room which contained comfortable seating and full screen projector for watching movies and television.

Bathrooms- LPA observed the bathrooms which contained wash your hands sign, hand soap, paper towels, and a trash cash. The bathrooms were neat and clean.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2023
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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ALBARIDA ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 197610218
VISIT DATE: 12/01/2023
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Backyard – The backyard is shaded and contains comfortable seating. The pool is surrounded by a locked gate. The music room is located on the west side of the backyard property. The Administrator stated will take the residents to the room and play while residents are listening to the Administrator's performance.

Garage- A refrigerator and freezer are also located in the garage. Emergency food and water were stored in the garage.



Laundry Room - The room was locked and contained the washer/dryer and laundry detergent.

Residents' Rooms - LPA observed three resident rooms contained night lamp, night stand, bed, linens, chair, and chest of drawers. The rooms were neat and clean.

Locked staff room was located on the second floor and LPA observed a bed available for a staff member. Linens and hygiene items were locked in an upstairs cabinet area.

Carbon Monoxide/Smoke Detectors - The carbon monoxide/smoke detectors were tested at 10:35 am and were properly working.

Resident Files – LPA reviewed the residents’ files and residents' P & I at 11:00 am until 12:00 noon. LPA did not observe any issues.

Staff Files – LPA reviewed the staffs' files at 12:00 pm until 12:20 pm. LPA did not observe any issues.


There are no deficiencies to report at this time. Exit interview was conducted, appeal rights discussed, and a copy of the signed report was given.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023
LIC809 (FAS) - (06/04)
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