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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610373
Report Date: 05/09/2023
Date Signed: 05/09/2023 01:41:50 PM


Document Has Been Signed on 05/09/2023 01:41 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:WESTCLIFF RESIDENTIAL CAREFACILITY NUMBER:
197610373
ADMINISTRATOR:MANABAT, EILEENFACILITY TYPE:
740
ADDRESS:39949 WESTCLIFF STREETTELEPHONE:
(626) 487-5691
CITY:PALMDALESTATE: CAZIP CODE:
93551
CAPACITY:6CENSUS: 3DATE:
05/09/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Eileen Manabat & Hazel DimasuayTIME 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 unannounced visit and was greeted by Administrators at 8:30 am. LPA stated the purpose of the visit was to conduct a case management visit. The facility was licensed on 3/08/2023 and LPA received an email from the Administrators on 4/19/2023 stating two residents now reside in the facility.

LPA and Administrator toured the facility from 8:55 am until 9:30 am. LPA observed a two-day supply of perishable food and a seven-day supply of non-perishable food. LPA observed the knives were locked in a kitchen cabinet. The cleaning products were safely locked underneath the kitchen sink. A fire extinguisher was also located in the kitchen. The laundry room was locked and the door that leads to the garage was also locked. LPA observed there were no safety issues when observed the backyard area. LPA observed the staff room was locked and the Administrators confirmed they are the live-in staff members. LPA did not observe any health or safety issues.

LPA reviewed residents' files at 9:30 am until 10:15 am. Resident records were complete, LPA reviewed staff records from 11:00 am until 11:10 am. Staff record were complete.

There are no deficiencies to report at this time. Exit interview, 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: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2023
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