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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610572
Report Date: 08/26/2024
Date Signed: 08/26/2024 11:54:56 AM

Document Has Been Signed on 08/26/2024 11:54 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:FREE TO BE PROGRAMS ARFFACILITY NUMBER:
197610572
ADMINISTRATOR/
DIRECTOR:		HUGHES, AUDREYFACILITY TYPE:
735
ADDRESS:6537 WEST AVE. L-7TELEPHONE:
(818) 366-6682
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 4CENSUS: 0DATE:
08/26/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:54 AM
MET WITH:Audrey Hughes & Jer'Marcus Dumas TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Evelin Rios conducted an announced Prelicensing  visit to complete Component III orientation. This is a new application for and Adult Residential Facility (ARF) Level 4i. LPA met with the applicant Audrey Hughes. Fire clearance inspection was approved on 02/21/24 with the approved capacity for four (4) ambulatory clients.

A tour of the physical plant inside and out was conducted with Audrey Hughes and Jer'Marcus Dumas at approximately 10:00 a.m.

Common Areas: These included the den, dining area and living area. The common areas were checked for cleanliness and furniture was checked for functionality. All areas were clean, sanitary and furniture was in good repair. In the den, LPA observed board games and sufficient space for activities. Dining table and couches sit the capacity of the facility. The facility was kept at a comfortable temperature.

Bedrooms:  LPA inspected four (4) client bedrooms. LPA observed bedrooms to be properly furnished and had adequate lighting. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress covers, and blankets. Bedroom also stored sufficient amounts of personal hygiene supplies.

Bathrooms:  LPA observed all two and half bathrooms to be clean, properly supplied with toilet paper, hand soup, paper towels and trash bins with lids. LPA observed bathrooms had functional fixtures.

Smoke detectors and Carbon Monoxide detectors were tested and observed to be functioning properly. Two (2) Fire extinguishers were fully charged and were purchased on 02/19/24.  (continued to LIC 809-C)
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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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: FREE TO BE PROGRAMS ARF
FACILITY NUMBER: 197610572
VISIT DATE: 08/26/2024
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(continued from LIC809)
There is a complete first aid kit with up to date manual in a linen closet and Emergency disaster kits appeared to be sufficient for the current capacity.

Kitchen:  The kitchen appliances and fixtures appeared functional. LPA observed refrigerator and freezer at proper temperatures. There was a sufficient amount of non-perishable foods properly stored in the kitchen cabinets. The facility telephone is located on the kitchen counter and was functioning properly. Knives and sharps are locked in a lock box in the laundry room cabinet inaccessible to clients.

Medications/Facility Files: LPA observed the office that will be maintained locked used for medication storage. Medication will be locked in individual lock boxes. Client and staff records will be maintained locked in the office.

Laundry/Garage: LPA observed the laundry room to be accessible to clients and detergent and cleaning supplies will be maintained locked in cabinets in the laundry room. The garage is accessible through the laundry room and the doors to the garage are maintained locked.

Surrounding Grounds (Outdoors): There is a gazebo and an umbrella for shade with proper furniture for outdoor use in the backyard.  There are no bodies of water on the premises. Entry/exits were free of obstruction. The outdoor area was clean and free of hazards.

Component III was conducted on site with Audrey Hughes & Jer'Marcus Dumas.

Pursuant to Title 22, Division 6, facility observed to be compliant with regulation.  Pre-Licensing is complete and this facility has no deficiencies observed.  A copy of this report will be forwarded to the application specialist. 

Exit interview conducted and report signed and issued.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC809 (FAS) - (06/04)
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