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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405850078
Report Date: 01/14/2023
Date Signed: 01/14/2023 02:01:11 PM

Document Has Been Signed on 01/14/2023 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:JULIE'S FAMILY HOMEFACILITY NUMBER:
405850078
ADMINISTRATOR:MARKS, JULIEFACILITY TYPE:
735
ADDRESS:1519 ETO CIRCLETELEPHONE:
(805) 458-2124
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93405
CAPACITY: 2CENSUS: 1DATE:
01/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Julie Marks / LicenseeTIME COMPLETED:
11:58 PM
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 At 9:00am on 01/13/2023, Licensing Program Analyst (LPA) Jeffries arrived unannounced at the facility to conduct the annual, infection control inspection. LPA met with Licensee Julie Marks and announced who he was and the reason for the visit.

Licensee and LPA conducted a cursory tour of the facility. This facility is a 3 bedroom, 2 living room 2 bathroom, kitchen and dining room, with a laundry room and a detached garage. There is a Caustics unit at the front of the facility. During the cursory inspection tour, LPA observed 30 day supply of PPE, supplemented by additional PPE provided by LPA. LPA noted that the water temperature was within regulation parameters. LPA noted that the one client is not prescribed any prescription medication. LPA observed a magnetic lock cabinet in the laundry room that stored the facilities chemicals. LPA observed wired fire detectors in each room throughout the facility and a carbon monoxide detector in the hallway that was tested and functioning correctly. LPA observed a fire extinguisher that was loaded and in the green pressure indicator. LPA observed at least two days of perishable and at least seven days of non-perishable foods on hand. LPA noted the facility is clean and it good repair and all exits were free and clear of obstructions. LPA noted that there were no violations or citations issued at as result of the cursory walk through tour on this date, at this time.

Licensee and LPA conducted the infection control module of the annual inspection. During the infection control module there were no violations, technical or citations issued at this time. LPA noted that there were no violation, technical, or citations issued at this infection control, annual.

Exit interview, report signed, and report emailed.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2023
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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