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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405800703
Report Date: 11/19/2024
Date Signed: 11/19/2024 01:38:33 PM

Document Has Been Signed on 11/19/2024 01:38 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:OPTIONS - CIS - ATASCADEROFACILITY NUMBER:
405800703
ADMINISTRATOR/
DIRECTOR:
CHRISTINA HUTCHISONFACILITY TYPE:
775
ADDRESS:5185 EL CAMINO REALTELEPHONE:
(805) 462-0550
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY: 25CENSUS: 16DATE:
11/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Verneda RobinsonTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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At 11:20 am on 11/19/2024, Licensing Program Analyst (LPA) Rankin arrived at the facility unannounced to conduct the annual inspection visit. LPA met with Program Supervisor Verneda Robinson and explained the reason for the visit.

LPA toured the facility with the Supervisor. The facility is maintained in conformance with state fire marshal regulations. Smoke detectors and carbon monoxide detectors were tested and were working at time of visit. Fire extinguishers are fully charged and last inspected 6/7/24. All Inside and outside passageways are free from obstruction. There are no bodies of water on the facility property. There is covered patio area with shade for the clients outside. The facility temperature was 70 degrees F. LPA observed a Hot water temperature log, temperature is tested monthly and tested within regulations of 105*-120*(f). A written disaster and mass casualty plan is readily available located on the facilities office wall. Clients are also serviced through Tri-Counties Regional Center. Clients meet at the facility in the AM then conduct their program at various locations throughout the community, which include landscaping jobs, they go into the community to enjoy activities, such as fishing, shopping, cooking, the library, animal shelter, and trail walks. The staff to client ratio is 3:1. Facility records and client records are located at this facility, staff records are located at a San Luis Obispo location. LPA was able to review current working staff annual training hours which are in compliance. LPA reviewed medications. Medications are stored in a locked cabinet in a locked office. LPA observed the Centrally Stored Medication Record (CSMR) and medications are given per physician's orders.

LPA will review personnel files at the San Luis Obispo office at a different time.

Exit interview done, copy of report provided.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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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