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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421701581
Report Date: 09/16/2022
Date Signed: 09/16/2022 02:00:56 PM

Document Has Been Signed on 09/16/2022 02:00 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:FRIENDSHIP ADULT DAY CARE CENTER, INC. DBA: FCOSBFACILITY NUMBER:
421701581
ADMINISTRATOR:HEIDI HOLLY 98FACILITY TYPE:
775
ADDRESS:89 EUCALYPTUS LANETELEPHONE:
(805) 969-0859
CITY:SANTA BARBARASTATE: CAZIP CODE:
93108
CAPACITY: 55CENSUS: 45DATE:
09/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Amy West, Associate DirectorTIME COMPLETED:
02:15 PM
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Licensing Program Analysts (LPA's) Olson and Cortez conducted an on-site 1 year infection control annual visit to the facility above on 09/162022 at 12:40 PM. LPAs met with Associate Director and explained the purpose of the visit.

LPA's took a physical plant tour of the inside and outside of the facility with Director.
The facility has an entry point where everyone entering completes sign-in and temperature check for all staff, clients, and visitors wanting to come into the facility. All documentation is kept in on file.

The facility has procedures and plans for screening, isolation, testing, when to call 911 and notifying all responsible parties and agencies when needed. Associate Director is in charge of infection control and provides training and education to staff, clients and visitors.

If any suspected or confirmed cases of Covid-19 are found inside or outside the facility a staff will use PPE supplies that will be located right outside of the isolation room when required. Facility has a 30 day supply of PPE on hand. The facility has proper cleaning and disinfectant policies. Facility has a plan in place for when and whom to notify in an outbreak or other emergencies. Facility has conducted training on infection prevention, symptoms, transmission and PPE use. Facility has non-punitive sick leave polices for staff. Sick staff are requested to stay home and not report to work if ill. Activities have been modified to individuals or small groups with social distancing. The facility ensures proper cleaning is done on frequently touched surfaces at least once a day. Sinks were well stocked with soap, paper towels and hand washing signs. Facility does realize guidance changes and the most up to date guidance from CCL-PINS, CDC, CDPH, and local health departments should be followed to remain in compliance. The most stringent orders should be followed by any of these agencies.

Continued on 809-C
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2022
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: FRIENDSHIP ADULT DAY CARE CENTER, INC. DBA: FCOSB
FACILITY NUMBER: 421701581
VISIT DATE: 09/16/2022
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At approximately 1:30 pm, LPA's reviewed Department of Social Services, Community Care Licensing Division, Licensing Information System (LIS), Facility Personnel and facility staff roster and determined that all staff are fingerprint cleared and associated to the facility

No deficiencies observed during the visit and all infection control protocols are implemented and are being followed. Exit interview completed and copy of report emailed to Administrator/ Licensee.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2022
LIC809 (FAS) - (06/04)
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