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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610295
Report Date: 07/22/2022
Date Signed: 07/22/2022 11:33:29 AM


Document Has Been Signed on 07/22/2022 11:33 AM - 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:1ST CARING TRADITIONSFACILITY NUMBER:
197610295
ADMINISTRATOR:MEDEL, REYFACILITY TYPE:
740
ADDRESS:3234 TOURNAMENT DRIVETELEPHONE:
(661) 441-0023
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:6CENSUS: 0DATE:
07/22/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Rey MedelTIME COMPLETED:
11:30 AM
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
LPA Spaeth conducted an announced pre-licensing visit and met with Rey Medel, Rolando Morales and Amy Morales. LPA conducted the Comp. III training from 9:00 am until 10:00 am. When entering the facility, LPA heard the egress alarm on the front door. The tour began at 10:10 am. Upon entering the facility, LPA observed the COVID signs on the door. A sign-in station has been set up at the front door and contained thermometer, hand sanitizer, sign in sheet, and masks. LPA observed a sitting room at the front entrance which contained comfortable seating.

A large room located at the south side of the facility is the kitchen/dining room/family room combination. The kitchen was spacious and consisted of wash your hands sign, and hand soap located at the kitchen sink. The locked cabinet underneath the sink contained cleaning supplies. The knives were safely locked in a kitchen drawer. The resident medications will be locked in a kitchen cabinet along with additional PPE supplies and first aid kit. The refrigerator was stocked with a four day supply of fresh vegetables and fruit. The freezer section contained frozen meats. The pantry was stocked with a seven-day supply of canned goods and pasta. LPA observed a fire extinguisher in the dining room area, and one at the front entrance. LPA tested the water temperature at 10:21 am which read 119.7 F. The smoke detector/carbon monoxide alarms were tested and reported working at 10:45 am. LPA observed the Let Us Know sign posted at the front door.

There are five bedrooms within the facility which each contained a bed, linens, night lamp, night stand, chest of drawers and spacious closet. The master bedroom is designated for a bedridden resident along with a master bath. The door exiting to the backyard has a workable egress alarm.ot

There are three bathrooms which contained slip resistant mat, grab bars, wash your hands sign, hand soap, paper towels, and trash can. The hallway has a storage closet which contained additional PPE and other supplies. Also, the hallway has cabinets where linens are stored.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa SpaethTELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2022
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 2


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: 1ST CARING TRADITIONS
FACILITY NUMBER: 197610295
VISIT DATE: 07/22/2022
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
26
27
28
29
30
31
32
The laundry room was locked and contained washer, dryer, cleaning supplies, hygiene items and laundry detergent. The door leading to the garage was locked and contained an additional refrigerator. The sliding glass door which leads to the backyard contains the alarm notification. LPA observed shaded area which has comfortable seating; the side gate leading to the front yard was not locked.

There are no deficiencies to report at this time. Exit interview conducted, appeal rights discussed, and a copy of the report was given to the Administrator.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa SpaethTELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2