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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405800142
Report Date: 01/23/2025
Date Signed: 01/23/2025 04:55:50 PM

Document Has Been Signed on 01/23/2025 04:55 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:CASA DE FLORESFACILITY NUMBER:
405800142
ADMINISTRATOR/
DIRECTOR:		JONATHAN D. ROBERTSFACILITY TYPE:
741
ADDRESS:1405 TERESA DRIVETELEPHONE:
(805) 772-7372
CITY:MORRO BAYSTATE: CAZIP CODE:
93442
CAPACITY: 120TOTAL ENROLLED CHILDREN: 0CENSUS: 74DATE:
01/23/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Jonathan RobertsTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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At 9:15 a.m. Licensing Program Analysts (LPA) Melisa Rankin arrived at the facility unannounced to conduct a required annual visit. LPA met with Administrator Jonathan Roberts and informed him of the reason for the visit.

From 9:36 a.m. - 11:35 a.m. LPA conducted a tour of the physical plant with Administrator to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The following was noted: Facility is a two story residence. LPA observed all required postings near the entrance area and the ombudsman poster near the elevator.

Emergency Disaster Preparedness plan is current, and forms were posted. The facility provides disaster drills monthly. LPA observed fire extinguishers throughout the facility, which were fully charged and last serviced on 4/25/2024, and 7/25/24. The facility provided an annual fire alarm test and inspection report as well as an alarm system review and sprinkler check, all done in 2024. Two evacuation stair chairs were observed on the 2nd floor in the common area and in the stairwells.

Kitchen: During the facility tour, the kitchen appeared clean and the appliances and fixtures functional. LPA observed sufficiently stocked food storage with two-day perishable and seven-day non-perishables. Food is prepared based on the menu. Snacks including fruit is available in the second-floor activities room and beverages are available for residents in the large dining room as well.

Common Bathrooms: LPA observed common bathrooms throughout the facility, which were properly supplied, with required signs and all had functional fixtures and grab bars.
Continued on LIC809-C.
Kelly BurleyTELEPHONE: (805) 562-0413
Melisa RankinTELEPHONE: (805) 635-4718
DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: CASA DE FLORES
FACILITY NUMBER: 405800142
VISIT DATE: 01/23/2025
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Common Areas: These included the fitness center, Frannies Ice Cream Shop, and dining areas. The common areas were checked for cleanliness and furniture was observed to be in good condition during time of visit.

Surrounding Grounds (Outdoors): LPA observed appropriate outdoor furniture in multiple areas which had umbrellas and shaded area for residents. Parking is available for residents and visitors.

Infection Control: The community's policies and procedures pertaining to infection control was reviewed prior to the visit and is appropriate.

Resident records were reviewed for requirements and legibility: LPA reviewed 5 residents’ files for Medical Assessments, Needs and Service plans, Signed Admission Agreements and Pre-appraisals. There were no issues with resident files reviewed.

Staff records were checked for expired or missing certificates and clearances: LPA conducted a file review of 5 staff for criminal record clearances/associations/and current First Aid. Submission of a newer staff who has scheduled training will be provided to LPA. All required annual and introduction training has been completed.

Residents with Special Health Needs: The facility does not accept dementia residents in care. The facility has a license for 120, all may be Non-Ambulatory. The facility does have hospice and home health visits to the facility for residents in care. Hospice waiver approved for 11.

LPA interviewed 5 staff.

Due to time restraints LPA will need to return at a later date.

Exit interview conducted and copy of the report was provided.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Melisa RankinTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
LIC809 (FAS) - (06/04)
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