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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610267
Report Date: 08/29/2022
Date Signed: 08/29/2022 12:04:27 PM

Document Has Been Signed on 08/29/2022 12:04 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:TRUE LIVINGFACILITY NUMBER:
197610267
ADMINISTRATOR:ROBERSON, THOMASFACILITY TYPE:
735
ADDRESS:2058 TOP CIRCLETELEPHONE:
(661) 585-0107
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 6CENSUS: 0DATE:
08/29/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Thomas RobersonTIME COMPLETED:
12:15 PM
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At 10:30 a.m., Licensing Program Analyst (LPA) Melissa Ruiz arrived at the facility to conduct an announced Pre-licensing inspection. Upon arrival LPA met with applicant Thomas Roberson. The facility will be licensed as an Adult Residential Facility. Facility is a single-story house with four (4) bedrooms and two (2) bathrooms. Facility has been approved for a capacity for six (6) clients.

The physical plant was toured inside and out at 10: 45 a.m. and LPA observed the following:

Common Area: LPA observed the living room and 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 74 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 are dual functioning and hard wired throughout the facility. The fire extinguisher was observed to be full and a purchase date of 3/31/22. Facility maintains a telephone landline that was tested and observed to be operational.

Kitchen Area: LPA observed the kitchen area to be in good repair and sanitary. A start up amount of perishable and non-perishable foods were observed. A cabinet with a lock will be used to keep sharps locked and inaccessible to clients in care. Trash containers have a tight-fitting lid.

Bedrooms: Facility has four (4) bedrooms, two (2) of which are shared bedrooms. All bedrooms were toured and were observed with the appropriate furniture and bedding and sufficient lighting was observed. There is a designated staff room located in the hallway that will be used for an office space. Medications and files will be kept in a locked closet located in the hallway. (cont. on LIC809-C)

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Melissa Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2022
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: TRUE LIVING
FACILITY NUMBER: 197610267
VISIT DATE: 08/29/2022
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Bathrooms: Facility has two (2) bathrooms. Bathrooms were toured and were observed to be clean. LPA observed sufficient towels and wash cloths for residents. No trash cans were observed.

Garage: Garage was toured. Facility has washer and dryer located inside the garage. Laundry chemicals will be in a cabinet inside the garage. Garage door is accessible through the dining area and is kept locked and inaccessible to clients. Garage area will be used as a storage area.

Outside: LPA observed appropriate outdoor furniture with a shaded area for residents. There is a shed in the backyard that will be used for storage and will remain locked and inaccessible to residents in care. There are no bodies of water.

Administrative: Pre-Licensing Self-Certification checklist was discussed with Administrator. LPA 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. No deficiencies were observed. Applicant/Administrator has completed component III.

Administrator to send photos of the following no later than 9/5/2022.

· Required infection control postings outside and inside throughout the facility.


· A visitor’s check in station with a visitor sign in log, thermometer, sanitizer, and PPE supplies.
· Trash cans with lids in two (2) bathrooms.

Upon completion of the following items, this report will be sent to Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when the license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Report has been signed and delivered. Exit interview conducted.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Melissa Ruiz
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022
LIC809 (FAS) - (06/04)
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