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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610232
Report Date: 03/28/2024
Date Signed: 03/28/2024 02:58:01 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/28/2024 02:58 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: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:
03/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:George McKayTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Lorena Casillas met with Administrator George McKay for an unannounced one (1) year Required visit for this facility.

LPA arrived at 09:40 am. The administrator was not in the facility or the area nor was there staff to grant access. LPA called Administrator and Administrator agreed to meet later. Administrator arrived and allowed entry at 12:00 pm. Entrance interview conducted. The tool kit was not used for this visit since there are no clients.

A tour of the physical plant was conducted with the Administrator at 12:40 am. The facility has four (4) bedrooms and two (2) bathrooms. It is currently not occupied by clients. Facility will have awake staff.


Living and Dining: LPA observed the living room furniture to be clean and in good repair. LPA observed the dining area to be clean and in good repair. The facility maintains a comfortable temperature at 68 degrees F. The smoke alarm and carbon monoxide detector were operational and tested at 1:23 pm. The fire extinguisher appears to be full, and last serviced on 12/07/21. Administrator will have fire extinguisher serviced and will provide a copy of the receipt. Files were observed to be in a locked cabinet located in the dining room.

Kitchen: LPA conducted a tour of the kitchen at 12:20 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. Food storage and preparation areas care clean and inaccessible to pests. Medications, knives, and sharp objects are kept centrally stored and locked in a cabinet located in the kitchen and in a cabinet towards the rear of the house.

Continued on LIC-809C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2024
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 2
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: 360 CARE, INC.
FACILITY NUMBER: 197610232
VISIT DATE: 03/28/2024
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Laundry: Cleaning supplies are kept locked and inaccessible in the laundry room.

Resident rooms: LPA observed rooms to have the appropriate bedding. There is a nightstand, dressers, a chair and sufficient lighting for each client.



Bathrooms: LPA observed both bathrooms which contained wash your hands sign, hand soap, paper towels, and trash cans with lids. Hot water was tested at 01:25 pm in the client bathroom and measured at 110.5 degrees Fahrenheit.

Physical environment: LPA toured the outside area of the facility at 01:30 pm. LPA observed appropriate outdoor furniture, with a shaded area for residents. No bodies of water on the premises.



Garage: The garage is attached to the facility. It is maintained locked inaccessible to clients and is used for additional storage.

Administrative: Administrator will email a copy of Surety Bond. Annual fees are not current. Administrator was advised that fees need to be paid immediately and proof needs to be emailed to LPA.



Resident Files: No clients.

Staff Files: LPA conducted a file review of Administrator records to ensure forms and training are up to date and compliance with licensing forms at 2:00 pm.

Medications: No medication, no clients.

Staff Interviews/Client Interviews: No staff or client interviews at this time.

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 Administrator.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
LIC809 (FAS) - (06/04)
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