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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320108
Report Date: 09/26/2023
Date Signed: 09/28/2023 04:04:48 PM


Document Has Been Signed on 09/28/2023 04:04 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
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:ATARAXIS HOMES #1FACILITY NUMBER:
198320108
ADMINISTRATOR:BUCKMAN, JAMESFACILITY TYPE:
740
ADDRESS:6732 WOOSTER AVETELEPHONE:
(323) 573-4554
CITY:LOS ANGELESSTATE: CAZIP CODE:
90056
CAPACITY:6CENSUS: 6DATE:
09/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:James BuckmanTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced Annual Required- 1 Year visit with the primary focus on Infection Control measures and using the new CARE Inspection Tool. Upon arrival at the facility, LPA Bunker conducted a risk assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA Bunker was properly screened for COVID-19 symptoms, and temperature was checked. LPA Bunker met with Licensee/Administrator Mr. Buckman and explained the purpose of today's Annual Inspection. LPA Bunker verified that the facility has an approved Mitigation Plan Report and Infection Control Report. There is currently six (6), resident in placement. The facility's annual fees are current.

The facility is a single-story-family home located in a residential neighborhood. Licensee/Administrator Mr. Buckman and LPA Bunker toured the facility which consisted of the following: Living room, dining room, kitchen, 7 bedrooms, 4 bathrooms, office area, laundry room, shaded area, indoor/outdoor activity areas, and attached garage. The front and back yard landscape is in good condition at the time of the visit.

During the tour, LPA observed the facility’s infection control practices. LPA observed sanitizer, visitor log, and thermometer at the facility entrance. Logs of daily COVID-19 screening and temperature checks of clients and staff were available and updated. PPE supplies are readily available to staff, and an additional supply of PPE was observed. Sufficient liquid soap, paper goods, cleaning, and disinfecting supplies were observed. LPA observed staff and residents wearing a face covering and social distancing. Due to time constraints, LPA was unable to complete the visit and will return back at a later date to complete the visit.
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela BunkerTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2023
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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