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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610232
Report Date: 02/14/2022
Date Signed: 02/14/2022 12:18:20 PM

Document Has Been Signed on 02/14/2022 12:18 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:360 CARE, INC.FACILITY NUMBER:
197610232
ADMINISTRATOR:MCKAY III, GEORGEFACILITY TYPE:
735
ADDRESS:45328 ROBINSON DRTELEPHONE:
(818) 201-5250
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: 0DATE:
02/14/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:George McKayTIME COMPLETED:
12:35 PM
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Licensing Program Analysts (LPAs) Shira Stamps and Joscelyn Martinez met with George McKay(Licensee/Applicant) for a Pre-licensing inspection at 10:25 am.

Entrance interview conducted.

The home will be vendored by North Los Angeles Regional Center. The home will serve four (4) level four (4) intellectually disabled adults. The facility has four (4) bedrooms and two (2) bathrooms designated for a capacity of four (4) clients. Staff will be awake at night.

The physical plant was toured inside and out at 10:25 am.

Common Area: LPAs observed the living room furniture to be clean and in good repair. LPAs observed the dining area to be clean and in good repair. The facility maintains a comfortable temperature at 68 degrees F, which meet regulations. The air conditioner is operational. No firearms observed or will be maintained on the premises.

The smoke alarm and carbon monoxide detector were operational and tested at 11:07 am. The fire extinguisher appears to be full, and last serviced on 12/12/21.

Files will be kept confidentially stored in a locked cabinet located in the dining room and supplied to licensing staff upon request.

Resident rooms: Rooms available are all private. LPAs observed rooms to have bedding sheets, pillowcase, blankets, mattress pads, which are in good condition. There is at least one chair, a nightstand, and sufficient lighting for each client. The mattresses and bedsprings were also checked for condition.

Window covering and window screens are in good repair for each room.

Consumers will have sufficient amounts of supplies for personal hygiene products, which is provided by the Licensee. Continued...

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2022
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 3
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: 360 CARE, INC.
FACILITY NUMBER: 197610232
VISIT DATE: 02/14/2022
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Bathrooms: LPAs toured resident bathrooms and checked to make sure bathrooms were clean and in good repair. The hot water temperature measured within regulations at 107.9 degrees F. The shower and bathtub in the master bedroom needs non slip mats. Trash cans with lids were in the restroom to protect consumers from cross contamination. Towels and washcloths will not be shared.

Kitchen Area: LPAs inspected the kitchen equipment. The refrigerator was clean and in good operation. Dishes in good repair. Cleaning supplies will be kept locked inaccessible in the laundry room.

Medications, knives, and sharp objects will be kept centrally stored and locked in a cabinet located in the kitchen. Stove and refrigerator are clean and in good operation. LPAs observed a startup supply of non-perishable and perishable foods.

Outside: At 11:01 am, LPAs toured the outside area. LPA observed a covered shaded area for clients. The facility has no bodies of water on the premises. The house on the left of the facility has a dog(s) that can potentially come over the exterior wall between the two houses. This is a potential risk to clients in care. The Licensee will provide an additional screen/fence on the wall to increase the height of the wall.

Garage: The garage is attached to the facility. It is maintained locked inaccessible to clients, and will be used for additional storage and an extra refrigerator.

LPAs discussed preplacement, staffing, training, customer service, inspection authority, reporting requirements (mandated reporter), records, citations, criminal record clearance, civil penalties, labor law, activities, expectation is to follow all rules and regulations.

Applicant/ Administrator has completed component III.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 360 CARE, INC.
FACILITY NUMBER: 197610232
VISIT DATE: 02/14/2022
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Exit interview conducted. Copy of report delivered.

Things to do:

1. The Licensee will provide a bigger complaint poster. The Licensee will send LPA a picture of the poster by 2/24/22.

2. The Licensee will post the wash your hands signs and COVID signs. The Licensee will provide LPA a picture of the signs posted by 2/24/22.

3. The Licensee will place two non-slip mats in the master bedroom. The Licensee will send LPA a picture of the mats installed by 2/24/22.

4. The Licensee will provide additional fencing/screening on the left side wall in the backyard. The Licensee will send LPA a picture of the fencing/screening by 2/24/22.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2022
LIC809 (FAS) - (06/04)
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