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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405802273
Report Date: 02/13/2023
Date Signed: 02/13/2023 11:06:18 AM

Document Has Been Signed on 02/13/2023 11:06 AM - 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:STARLING HOMEFACILITY NUMBER:
405802273
ADMINISTRATOR:DEBORAH STARLINGFACILITY TYPE:
735
ADDRESS:872 SYCAMORE CANYON RDTELEPHONE:
(805) 237-7307
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 6CENSUS: 6DATE:
02/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:09 AM
MET WITH:Deborah Starling / LicenseeTIME COMPLETED:
11:05 AM
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 At 8:00am on 02/13/2023, Licensing Program Analyst (LPA) Jeffries arrived at the facility unannounced to conduct the annual, infection control inspection. LPA met with care giver Deeann Williams (S1) and announced who he was and the reason for the visit. S1 contact Licensee Deborah Starling by phone who arrived at the facility shortly after contact.
Licensee and LPA conducted a cursory tour of the facility. LPA noted that the facility is a six bedroom, two and a half bath room, with one room being double client occupancy, four rooms are single client occupancy and a full time staff occupies the sixth bedroom. The full time staff has a full bathroom in the master bedroom and the clients share the upstairs full bathroom and the downstairs half bathroom, LPA noted that the fire detectors are located throughout the facility and were tested and are in good working order. LPA noted that the carbon monoxide detector upstairs is also functioning properly. LPA observed at least two days supply of perishable and at least seven day supply of non-perishable foods on hand at the facility. LPA observed liquid soap and paper towels in the bathrooms. LPA observed at least a 30 day supply of PPE on hand at the facility. LPA noted that the medication cart is locked and located between the living room and dining room during time of visit. LPA noted that water temperature is within regulation parameters of 105*-120*(f). LPA noted that the facility is very clean and in good repair. No exits were obstructed and hazards were observed. LPA noted that there were no violations, technical, or citations issued on the cursory tour of the facility.
Licensee and LPA conducted the infection control module of the annual inspection. LPA noted that no violations, technical, or citations were issued during the infection control module of the annual inspection. LPA noted that there were no violations, technical, or citation issued at this time during the annual, infection control inspection.

Exit interview, report singed, and report delivered.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2023
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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