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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405801561
Report Date: 09/20/2024
Date Signed: 09/20/2024 02:01:51 PM

Document Has Been Signed on 09/20/2024 02:01 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:TRAFFIC WAY HOUSEFACILITY NUMBER:
405801561
ADMINISTRATOR/
DIRECTOR:		DEBBIE STARLINGFACILITY TYPE:
735
ADDRESS:5000 TRAFFIC WAYTELEPHONE:
(805) 466-0721
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY: 14CENSUS: 6DATE:
09/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:14 AM
MET WITH:Administrator, Debbie StarlingTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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 At 10:30AM on 09/20/2024 Licensing Program Analyst (LPA) Jeffries arrived at the facility unannounced for annual inspection visit. LPA met with Administrator, Debbie Starling, announced who he is and the reason for the visit.
The facility is a 8 bedroom, 3 bathroom facility. All bedrooms are capable of double client occupancy. This is a Tri-Counties vendor facility. The facility maintains conformity with State Fire Marshall regulations. The facility does not have any bodies of water on the premises. All outdoor and indoor passageways are free of obstruction. Disinfectants, cleaning solutions are stored in the locked laundry room inaccessible to clients in care. Lamps and lights are present in all rooms to ensure the comfort and safety of all clients. Hot water temperature is maintained within regulation. All toilets, hand washing, and bathing facilities are safe, sanitary, and in operating condition liquid soap and paper towels. The licensee ensures that each client has clean linen in good repair, including blankets, bedspreads, top and bottom sheets, pillow cases and mattress pads, and bath towels, hand towels and washcloths. Facility has one functioning carbon monoxide detector and functioning smoke detectors in all client rooms and common area living room. All food is selected, stored, prepared, and served in a safe and healthful manner with at least 2 days off non-perishable and 7 days of perishable foods on hand at this facility. All foods are protected against contamination. The licensee provides those services identified in the clients needs and services plan as necessary to meet the clients needs. Medication is kept in a safe and locked medication cart in the office which is not accessible to persons other than employees responsible for the supervision of centrally stored medication. LPA observed a updated Emergency Disaster form (LIC610D) and Infection control plan (LIC92832),
LPA conducted a cursory review of medications, staff and client files. Administrator and LPA conducted a full review of the annual care tools and had no citations or violations. LPA conducted one staff interview, all clients were at day programs.
.Exit interview conducted and copy of report provided. .
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2024
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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