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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405850573
Report Date: 01/10/2025
Date Signed: 01/10/2025 12:29:33 PM

Document Has Been Signed on 01/10/2025 12:29 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:MADRIGAL'S LIVE LAUGH LOVE HOMEFACILITY NUMBER:
405850573
ADMINISTRATOR/
DIRECTOR:		HAWKE, JULIAFACILITY TYPE:
735
ADDRESS:9385 N SANTA MARGARITA RDTELEPHONE:
(805) 835-7036
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY: 4CENSUS: 0DATE:
01/10/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Alicia Madrigal, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:35 PM
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Licensing Program Analyst (LPA) De Leon conducted an announce PreLicensing visit to the facility above. LPA met with Licensee Alicia Madrigal and explained the purpose of the visit.

LPA conducted a tour with Licensee of the physical plant both inside and outside.

Infection Control: The has pad of paper at entry to sign in and out. The facility has 30 days of Personal Protective Equipment (PPE). LPA reviewed infection control plan with Licensee and the plan is posted in the common area living room. Trash bins stored outside have coverings.
Cleaning and Disinfection will be completed by staff on an ongoing bases. Staff will be trained up hiring and annual thereafter on infection control and PPE usage.

Physical Plant/Environmental Safety: The facility has separate carbon monoxide and smoke detectors present. Licensee tested and alarms are working properly. The facility is clean, safe, sanitary and in good repair. All windows and screen are in good repair through the facility. All out door and indoor passageways are clear and no obstructions were observed. There are no bodies of water present at the facility. Disinfectants, cleaning and laundry products are stored in locked cabinets in the laundry room, and locked garage cupboards. Firearms and ammunition are stored in locked safes and stored in separate lock boxes in separate cupboards. Medications will be stored in a locked cupboard in the living room. The lighting through out the facility is safe and comfortable for resident use. Faucets deliver hot water and water was tested at 112.7 at the kitchen sink and 112.3 in the resident bathroom. The facility does not have a hot water tap. The resident bedrooms are double occupancy with beds, dressers, closet space, lighting and lamps. Mattress are in good conditions and the facility has plenty of clean linens. The facility has night lights in halls.


Continued 809-C
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: MADRIGAL'S LIVE LAUGH LOVE HOME
FACILITY NUMBER: 405850573
VISIT DATE: 01/10/2025
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Operation Requirements: The facility will be licensed for a capacity of 4. The facility has a plan of operation on file. The fire clearance is approved for 4 ambulatory residents with age range of 18-59. Sample Menus are posted in the common area living room. The facility has a surety bond for handling residents cash resources. The facility has a backyard deck in good repair with an umbrella for shade and out door furniture. All recreational supplies are stored safely for resident use. There is a very large yard of the beck deck and around the property. The property is fully fenced in the back and side yards.

Personal Records/Training: The facility does not have staff currently. All confidential forms and files will be stored in the a locked filing cabinet in the garage.
Client Records/Incident Reports: The facility does not have residents at this time. The files will be stored with resident records kept confidential in locked filing cabinets in the gage. Licensee will notify Community Care Licensing (CCL) as soon as the first resident move in. Incident report will be completed by Licensee or Administrator and sent to CCL when required.

Food Service: The kitchen is clean, safe and sanitary. The facility is kept free of flies, insects and rodents. The freezer is kept at 0 degrees and refrigerator is kept at 45 degrees. The facility does currently have 7 days of Non-perishable and 2 day of perishables as well as emergency food and water. Items that can pose danger such as sharps and knives will be locked in the cupboards over the kitchen stove. Cleaning items will be stored in locked cupboards in the laundry room, separate from food supply.

Health Related Services: The facility has a first aid supply kit, stored and locked in living room cupboards. Centrally stored medication will be stored and locked in living room cupboards.

Disaster Preparedness: The current disaster plan is posted in the common area of the facility and meets all requirement using the LIC 610D form. The facility sketch shows all emergency exits. The facility has plans for training and quarterly drills covering different scenarios. The facility has plenty of flashlights and batteries for emergencies. The facility has back up food supply and water.

Comp III was completed with LPA and Licensee.
Pre- Licensing is completed and this facility has no deficiencies.
Exit interview conducted and copy of report printed for Licensee.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025
LIC809 (FAS) - (06/04)
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