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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610654
Report Date: 11/15/2024
Date Signed: 11/15/2024 11:16:21 AM

Document Has Been Signed on 11/15/2024 11:16 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:CHRISTIAN ANGELFACILITY NUMBER:
197610654
ADMINISTRATOR/
DIRECTOR:		KAYIIRA, KASIBANTE AFACILITY TYPE:
735
ADDRESS:44526 PALO VERDE DRTELEPHONE:
(661) 523-5398
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY: 4CENSUS: 0DATE:
11/15/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Kasibante Kayiira / ApplicantTIME VISIT/
INSPECTION COMPLETED:
11:30 PM
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On 11/15/2024 Licensing Program Analyst (LPA) Evelin Rios arrived at the facility to conduct an announced Pre-licensing Inspection. Upon arrival, LPA met with applicant/licensee Kasibante Kayiira / Christian Angel. This is an application for an Adult Residential Facility and has been approved for a total capacity of four (4) ambulatory clients. The facility is a one story home with four (4) bedrooms and two (2) bathrooms.

Dinning Area/Living room: LPA observed the furniture to be clean and in good repair. LPA observed a dinning table with chairs that sit the capacity of the facility. LPA observed couches in good repair that sit the capacity of the facility. Common areas are spacious with room for activities. LPA observed a fire place secured with a screen.

Kitchen: LPA observed the kitchen area to be clean and clutter free. LPA observed appliances to be in good repair. Knives, sharps and medication will be stored in a locked kitchen cabinet, inaccessible to clients. No cleaning chemicals will be stored in the kitchen area. First aid kit was observed with all the appropriate requirements. The fire extinguisher was observed to be fully charged with a purchase date of 06/30/2024.

Outside: LPA observed a covered patio that provides a shaded area for clients. Backyard has enough space for outdoor activities. There are no bodies of water.

Bedrooms: All bedrooms were toured and observed with appropriate furniture, bedding and lighting.

LPA observed smoke detectors through out the facility. Smoke detectors are hardwired and interconnected. The smoke detectors and carbon monoxide detector were tested by applicant and observed operational at 9:48 a.m.

Bathrooms: Facility has two (2) bathrooms designated for client’s use. Bathrooms were toured and were observed clean and appropriately supplied with paper towels, hand soap and toilet paper . Hot water was tested and measured 113 degrees Fahrenheit. LPA observed sufficient towels and wash cloths for clients. Facility has extra towels and bed sheets in a hallway cabinet.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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: CHRISTIAN ANGEL
FACILITY NUMBER: 197610654
VISIT DATE: 11/15/2024
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Laundry/Garage: Facility has a garage that is accessible through the laundry room. Laundry room is accessible to clients. LPA observed a washer and dryer that appeared operational. Detergents, cleaning products, and facility files will be stored in a locked cabinet in the laundry room. Garage is currently used for storage.


Pre-Licensing is complete and this facility has no deficiencies.

Component III was conducted during this visit with Kasibante Kayira and Margaret Kayiira.

This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved. Failure to comply could affect the approval of your license.


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

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
LIC809 (FAS) - (06/04)
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