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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405800467
Report Date: 10/28/2024
Date Signed: 10/28/2024 03:09:10 PM

Document Has Been Signed on 10/28/2024 03:09 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:GARDEN CREEKFACILITY NUMBER:
405800467
ADMINISTRATOR/
DIRECTOR:
LIZA HIXFACILITY TYPE:
740
ADDRESS:73 BROAD STREETTELEPHONE:
(805) 543-2311
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93405
CAPACITY: 72CENSUS: 46DATE:
10/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Liza HixTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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At 9:45am on 10/28/2024, Licensing Program Analyst (LPA) De Leon arrived at the facility unannounced to conduct the annual inspection. LPA met with Administrator Liza Hix and explained the purpose of the visit.

This facility has 64 bedrooms/bathroom. This facility is 3 stories, the first floor there is a large waiting and entrance way with front desk. There is an enclosed center courtyard, there is a kitchen and dining room, resident rooms, mail room, storage rooms and facility offices. The second floor has a beauty salon, storage rooms, central medication room, activities room and resident suites. The 3rd floor has resident rooms, locked storage closets, and an activities/library room. The grounds also have independent living facilities located next door and plenty of outside seating and walking ways for residents. There is a designated smoking area in the back parking lot of the grounds. Administrator and LPA conducted a tour of the facility, LPA observed, all floors, kitchen, dining room, all activities rooms, medication room and 10 residents rooms. LPA noted that there are fire extinguishers placed throughout the facility all in the green and currently tagged for service. LPA noted that the facilities walkways and exits were free and clear of debris or obstructions. LPA noted that the food supply met regulations for 2 days of perishables and 7 days of non-perishables for more than 46 residents. LPA conducted an audit of medications, medications was stored in original container, no medications were expired and no labels were altered. LPA reviewed 5 staff files, all required forms were present. LPA reviewed 5 resident files, all required forms were present.

No other violations, or citations were discovered during this annual inspection.
LPA interviewed 3 staff and 2 residents.

Exit interview, copy of report printed for Administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2024
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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