<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610267
Report Date: 10/04/2024
Date Signed: 10/04/2024 03:30:15 PM

Document Has Been Signed on 10/04/2024 03:30 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:TRUE LIVINGFACILITY NUMBER:
197610267
ADMINISTRATOR/
DIRECTOR:		ROBERSON, THOMASFACILITY TYPE:
735
ADDRESS:2058 TOP CIRCLETELEPHONE:
(323) 542-5202
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 6CENSUS: 0DATE:
10/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:44 PM
MET WITH:Thomas RobersonTIME VISIT/
INSPECTION COMPLETED:
03:44 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Evelin Rios arrived at the facility above to conduct an annual required visit. LPA was greeted by the new administrator Heaven Roberson. The Licensee Thomas Roberson, met LPA shortly after. LPA explained the reason for the visit. Licensee stated the facility is working with the North Los Angeles County Regional Center to be vendorized. As of today the facility has not admitted any clients. This facility is licensed as an Adult Residential Facility with approved fire clearance for six (6) ambulatory clients. Licensee informed LPA they may need to change the ambulatory status. LPA informed licensee to email the LIC200 requesting the change and an updated facility sketch.

LPA conducted a physical plant tour of the facility. In the kitchen LPA observed a seven day supply of non perishable food: properly stored. LPA observed the fire extinguisher fully charged. Licensee tested the carbon monoxide and fire detectors at 2:53 p.m. LPA observed detectors operational.

LPA discussed with the licensee the administrator certification. Licensee informed LPA they have hired a new administrator. LPA requested required documentation be emailed to LPA to conduct a change of administrator. LPA reviewed the Active Administrator Certification list. Administrator's name was on the list. LPA reviewed licensee's 1st aid and CPR. 1st aid and CPR is up to date. LPA provided Licensee a copy of the PIN to pay due license fee online. Licensee stated fee will be paid by end of day and a copy of confirmation sent to LPA via email. Inspection Tool not used for today's visit.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, there were no deficiencies observed during today's visit. Exit interview conducted. Copy of the report provided.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2024
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 1