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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405800333
Report Date: 03/01/2022
Date Signed: 03/01/2022 07:09:48 PM

Document Has Been Signed on 03/01/2022 07:09 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:C.A.L.L.-PALOMAR HOUSEFACILITY NUMBER:
405800333
ADMINISTRATOR:REGINA R. CEASARFACILITY TYPE:
735
ADDRESS:8902 PALOMARTELEPHONE:
(805) 462-2421
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY: 6CENSUS: 6DATE:
03/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Regina Ceasar, Administrator, and Madison Mitchell, Lead Residential TrainerTIME COMPLETED:
02:15 PM
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On 3/01/22 at 12:50 pm, Licensing Program Analyst (LPA) Chavez conducted an unannounced on-site annual infection control visit to the facility above. LPA met with Administrator Regina Ceasar and Madison Mitchell, Lead Residential Trainer and explained the purpose of the visit.

LPA toured the facility with Lead Residential Trainer and observed the following: The facility has signage at the front door directing visitors to enter at the garage or phone the facility at 805-462-2421. Upon entry to the garage, LPA was screened. Staff are wearing masks properly. The facility has hand sanitizing dispensers and paper towel dispensers in the kitchen and bathrooms (2). Bathrooms and kitchen sinks are stocked with soap. The facility has signage for COVID infection control measures including cough etiquette and handwashing reminders. Fire extinguishers are located in the garage and kitchen and are fully charged and were inspected on 11/08/21.

At 1:17 pm, LPA conducted the Infection Control mitigation module with the administrator and lead residential trainer. Administrator states staff are not being tested for COVID during the hiring process. Administrator has committed to changing the procedure so that staff are being tested prior to onboarding. No deficiencies cited.

Exit interview conducted and report emailed to the administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2022
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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