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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610310
Report Date: 04/20/2024
Date Signed: 04/20/2024 11:45:33 AM

Document Has Been Signed on 04/20/2024 11:45 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
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:HODGES HOMES INC.FACILITY NUMBER:
197610310
ADMINISTRATOR/
DIRECTOR:		KING, MARLONFACILITY TYPE:
735
ADDRESS:37137 CANNON CTTELEPHONE:
(661) 860-4425
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY: 4CENSUS: 0DATE:
04/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:07 AM
MET WITH:Cheryl Hodges - OperatorTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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An unannounced Required One (1) year visit was conducted on this day by Licensing Program Analyst (LPA) Gary Tan. LPA initially met with Licensee Representative Cheryl Hodges and explained the reason for the visit. This will be a North Los Angeles Regional Center (NLARC) vendored facility Level III, application is till pending with NLARC at this time.

LPA conducted physical plant tour inside and out at 9:20 AM. During the tour, LPA observed that the facility has four (4) bedrooms and three (3) bathrooms. There is no body of water in the facility.

The facility had submitted and approved Mitigation and Infection Plan.

The front main door is the only entrance being utilized at the facility. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. The facility had submitted and approved Mitigation and Infection Plan. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. All trash cans were observed to be with cover.

The facility has a designated visitors' area at the back yard. The facility has sufficient stock of PPE in the storage

Bedrooms were toured and observed to be clean and appropriately furnished.

Bathrooms were observed to be clean, sanitary and with necessary supplies. Hot water temperature measured at a range of 110.8°F to 118.1°F.

(continued on LIC 809-C)
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE: DATE: 04/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/20/2024
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.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: HODGES HOMES INC.
FACILITY NUMBER: 197610310
VISIT DATE: 04/20/2024
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(continued from LIC 809)

Physical plant was checked for cleanliness and condition. Facility was observed to be in good repair and clean during today's visit.
Living and dining room furniture were also checked for functionality (wear and tear). Furniture was observed to be in good condition.
Kitchen area is observed to be clean and sanitary. All disinfectants, cleaning solutions and laundry detergents were observed to be locked in the laundry room.
Food. The facility is observed to have sufficient food supply for clients. Temperature of facility wall thermostat was set at 74.0°F and observed to be within the required range.
Fire extinguisher was observed to be located by the kitchen. Extinguisher was observed to be operable and last inspected on 06/20/23. Fire alarms are hardwired and interconnected, tested and observed to be operational. There is a carbon monoxide detector installed in the facility.
Medication cabinet was observed to be locked. The medication cabinet is located in the kitchen. There was a complete first aid kit located in the medication cabinet. Knives and sharps are also locked and secured cabinet in the kitchen.
Garage is attached to the house and observed to be locked and inaccessible to clients. Laundry room is located in a room leading to the garage. Garage is also used as frozen food, emergency supplies and tools and old equipment storage.

Client records. No client at this time.

There was no health and safety hazard observed during the day of inspection.

Exit interview conducted and a copy of this report was given.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2024
LIC809 (FAS) - (06/04)
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