405801490-8-12-2024-29-AS-MRAN-D83TYG-20240812150843

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 405801490
Report Date: 08/12/2024
Date Signed: 08/12/2024 03:08:59 PM

Document Has Been Signed on 08/12/2024 03:08 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:	FRANCISCAN RESIDENCE, THE		FACILITY NUMBER:	405801490
ADMINISTRATOR:	FRANCYN JOYCE ALTAMIRA		FACILITY TYPE:	735
ADDRESS:	4130 LOBOS AVENUE		TELEPHONE:	(805) 462-8512
CITY:	ATASCADERO	STATE: CA	ZIP CODE:	93422
CAPACITY:	4	CENSUS: 4	DATE:	08/12/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:01 AM
MET WITH:	Francyn Altamira		TIME COMPLETED:	03:15 PM

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On 8/12/24 at 9:50 am, Licensing Program Analyst (LPA) Rankin conducted an unannounced Annual/Required visit to the facility listed above. LPA met with Francyn Altamira, Administrator, and explained the purpose of the visit.

LPA toured the facility with the administrator. The clients returned from day program at the end of the visit. The facility is maintained in conformity with state fire marshal regulations. The facility has an Emergency Disaster Plan (LIC 610D). The smoke detectors and carbon monoxide detector were tested and functioning properly. Fire extinguishers (2) were located in the entry and laundry room. Extinguishers were fully charged and last inspected on 4/19/24. There are no pools or bodies of water and no firearms or dangerous weapons stored. All toilets and hand washing facilities are maintained in a safe, sanitary, operating condition. The inside of the facility is clean, safe, sanitary and in good repair for the safety and well-being of clients, employees, and visitors. Outside the facility is going to have some updates made to the fence, a gate, and the facility will monitor an area outside the bathroom wall to ensure stucco remains clean and sanitary. Each client is accorded safe, healthful, and comfortable accommodations, furnishings, and equipment to meet his/her needs. There is a minimum 2-day supply of perishables and 7-day supply of nonperishable foods. Food is stored and prepared in a safe and healthful manner. Disinfectants, cleaning solutions and poisons are inaccessible to clients. The facility has adequate emergency supplies and first aid supplies. Outdoor walkways are free from obstruction and the facility has outside covered patio areas for individuals to use.

Continued on 809-C.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Melisa Rankin	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2024

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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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: FRANCISCAN RESIDENCE, THE	FACILITY NUMBER: 405801490
	VISIT DATE: 08/12/2024

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LPA reviewed (5) staff files for criminal record clearances and associations, Health screening with TB results, and current First Aid/CPR. Staff records reviewed are in-compliance.

LPA reviewed four (4) client files for current health records, needs and services plans, signed admission agreements and personal rights. All records reviewed are in-compliance.

Clients’ centrally stored medications are kept in a locked cabinet in the dining room. Medications are given as prescribed by doctors’ orders.

Exit interview conducted, and the report given.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Melisa Rankin	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2024

LIC809 (FAS) - (06/04)

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