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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610484
Report Date: 01/17/2024
Date Signed: 01/17/2024 12:29:45 PM

Document Has Been Signed on 01/17/2024 12:29 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:ALLWALKS THRULIFE RESIDENTIAL, INCFACILITY NUMBER:
197610484
ADMINISTRATOR:WALLACE, ANDREAFACILITY TYPE:
735
ADDRESS:4138 VAHAN CTTELEPHONE:
(909) 619-9321
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 2CENSUS: 4DATE:
01/17/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Andrea WallaceTIME COMPLETED:
12:30 PM
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On 01/17/2024 at 10:00 am, Licensing Program Analyst (LPA) Evelin Rios conducted an announced Pre-Licensing Inspection at this facility. LPA met with Administrator/Licensee Andrea Wallace. An application to operate an Adult Residential Facility (ARF) was received by Community Care Licensing (CCL) on August 08, 2023. A fire clearance was approved on 09/19/2023, for four (4) ambulatory clients for a total capacity of four (4). LPA explained the purpose of today’s visit to the applicant.

A tour of the physical plant was initiated at approximately 10:05 a.m. and the following was observed: This is a two story facility with an attached garage. Upon entrance LPA observed required postings on a wall leading to the client bedrooms.

KITCHEN: The kitchen area was clean and clear of clutter. LPA observed a refrigerator, microwave, stove/oven, dishwasher and sink to be operational. There was a two-day supply of perishable and seven-day supply of nonperishable food; properly stored. LPA also observed plates, cups and cutlery for the capacity of the facility. Knives, cleaning supplies and chemicals will be kept locked in the kitchen cabinet under the sink.

BEDROOMS: There are a total of five (5) bedrooms, bedroom #1, bedroom #2 and bedroom #3 are designated for client use. According to the applicant their intentions are to only use bedroom #1 and bedroom #2 for clients. Applicant intends to keep both rooms, private and not shared. The applicant furnished the client bedrooms with beds, night stands, chairs, dressers, bedding and appropriate lighting.

BATHROOMS: The facility has three (3) total bathrooms. One bathroom is located in bedroom #3, currently designated as a staff room. Two (2) bathrooms designated for client use were observed to have paper towels, hand soap, toilet paper, trash bins and extra toiletries for clients. The hot water delivered in the bathrooms measured between 105 - 120 degrees F. Continued on 809-C
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2024
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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ALLWALKS THRULIFE RESIDENTIAL, INC
FACILITY NUMBER: 197610484
VISIT DATE: 01/17/2024
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COMMON AREAS: These included two sitting areas and a dining area. Sitting areas included furniture that sits the capacity of the facility. One sitting area furnished a television, console that stored games, and a screened fire place. No fireplace tools present. The dining room table is large enough to accommodate the capacity of the facility. Dining area has a deep freezer for overflow of food. Facility telephone not operational at time of visit.

The smoke alarms are hard wired and inter-connected. Applicant tested smoke detectors at 10:21 a.m. and LPA observed them to be functioning properly. The carbon monoxide detector was observed functional. The facility has two (2) fire extinguishers that were fully charged and last serviced on 09/11/2023.

LAUNDRY ROOM: The laundry room is located on the second floor. Cleaning detergents and supplies will be maintained locked in a cabinet above the washer and dryer. Locked to be added before 01/26/2023.

GARAGE: The garage is attached and accessible to clients. The garage is currently used to store an over flow of facility items.

MEDICATIONS & RESIDENT RECORDS: Medications will be stored in a locked stand alone cabinet by the living area and kitchen. Client records will also be stored in the same locked cabinet.

STAFF Records: Staff records will be stored in a locked cabinet, in the staff bedroom. The applicant was advised to ensure all records will be accessible to the licensing agency upon request or during inspection.

SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. The backyard of the facility has a patio for shade. The facility backyard has sufficient yard space to accommodate outdoor activities. There are no bodies of water.

The Component III presentation was conducted at approximately 11:30 a.m. with administrator/licensee. Pre-Licensing is incomplete with deficiencies to be resolved by01/26/2023. A follow up Pre-licensure LIC809 will be generated upon resolution of deficiencies."



Exit Interview was conducted, and a copy of this report was given to applicant.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2